Programs High-Risk Medicines

Neuromuscular Blocking Agents

Neuromuscular blocking agents are considered high-risk medicines because inadvertent use in patients without the availability of medical staff skilled in airway support can lead to respiratory arrest, permanent harm, or death.

Significant Incidents

Significant incidents have occurred involving inadvertent administration of a neuromuscular blocking agent to a patient instead of a sedative.

Identified contributing factors to incidents involving neuromuscular blocking agents include:
  • Look-alike packaging and labelling
  • Sound-alike medicine names
  • Drug administration after extubation
  • Use of pre-prepared unlabelled syringes
  • Unsafe storage, particularly small quantities in refrigerators
  • Use in clinical areas where clinical staff may be unfamiliar with the drugs and their action.


Neuromuscular Blocking Agents Standard

The Neuromuscular Blocking Agents Standard of the NSW Health High-Risk Medicines Management Policy (PD2015_029) outlines the minimum actions required to reduce risks associated with neuromuscular blocking agents. The Neuromuscular Blocking Agents Standard includes a risk mitigation strategy, and addresses neuromuscular blocking agent storage, supply and administration.

The tool below can also be used to assist hospitals in monitoring risks associated with neuromuscular blocking agents. It can also be used to monitor local implementation and compliance with the Neuromuscular Blocking Agents Standard of the High-Risk Medicines Management Policy.