The safety of injectable drugs—particularly intravenous drugs—remains a high-risk area in healthcare, despite progress in terms of human factors and ergonomics. This article highlights how poorly designed systems perpetuate persistent dangers, and why a systemic approach must go beyond mere calls for vigilance.
1. The security paradox — progress vs. actual practice
In many high-risk fields (aviation, nuclear power), human factors principles have transformed safety. Healthcare has adopted some of these approaches (checklists, feedback culture), but injectable drug administration remains a structural weak point —particularly in anesthesia, emergency medicine, intensive care, and pediatrics.
The French National Agency for Medicines and Health Products Safety (ANSM) provides recommendations and updates on medication risk management and best practices: https://www.ansm.sante.fr
2. Medication errors: systemic causes
Intravenous medication errors are not simply individual mistakes—they reflect systems where:
- the packaging looks the same,
- concentrations vary,
- The preparation devices are poorly standardized.
Human factors show that vigilance alone is not enough: the system design must reduce opportunities for error.
3. Standardization and best practices
The standardization of practices —in the choice of products, concentrations, labeling, and procedures—is a major lever but is still insufficiently applied.
Learned societies such as the French Society of Anesthesia and Intensive Care (SFAR) and the French Society of Clinical Pharmacy (SFPC) produce professional recommendations that help to structure this standardization.
📌 SFAR (French Society of Anesthesia and Intensive Care) — recommendations on anesthesia and safety practices: https://www.sfar.org
📌 SFPC (French Society of Clinical Pharmacy) — recommendations on clinical pharmacy and medication safety: https://www.sfpc.eu
These resources offer methodological guides, training, and expert consensus to structure practice and reduce dangerous variations.
4. The myth of vigilance
Traditional approaches in healthcare settings still too often rely on messages such as "be more vigilant." In human factors theory, this type of injunction does not address the root causes: cognitive load, interruptions, fatigue, and organizational constraints make errors statistically inevitable if the system has not been designed to prevent them.
5. Ready-to-Administer and Error Reduction
One key solution identified in several international studies is the use of ready-to-administer drugs, which are industrially prepared to reduce risky preparation steps.
The data suggest that these solutions:
- significantly reduce errors,
- reduce infections,
- lighten the burden of caregiving,
- can reduce the overall costs associated with errors.
This type of systemic approach is at the heart of the best practice recommendations promoted by the SFAR and SFPC in their publications.
6. Theory vs. prescribed practice
Many written procedures do not reflect what happens in everyday practice. There is a wide gap between prescribed work and actual work, which encourages normal but dangerous deviations from the rules. Procedures must be changed to take into account the real constraints in the field and ergonomic principles.
7. Towards a cultural revolution
The article calls for a cultural revolution in drug safety:
- integrate human factors principles into system design;
- strengthen the standardization of practices;
- promote ready-to-use devices;
- promote robust professional recommendations.
This transformation is not based on blaming caregivers, but on improving systems—where the real opportunities for reducing errors and improving patient safety lie.
