Unlike the “Forever” stamps from the US Post Office, we should not keep using multi-dose vials until the vial is empty. Multi-dose vials are  to be discarded 28 days after first use, unless the manufacturer specifies otherwise (shorter or longer), according to the Joint Commission Medication Management Standards FAQ about multi-dose vials.

So you say, I do put the date when I first open/puncture a multi-dose vial. Ok, but not good enough says the Joint Commission. To be in compliance with MM.03.01.01 EP 7, The Joint Commission requires organizations to re-label multi-dose vials with a revised expiration date once the multi-dose vial is opened or punctured. Just labeling the multi-dose vial with the date opened will not meet the intent of this requirement.  The label should look something like this.

Medications in single use vials are preferred over multi-dose vials but avoid the urge to use single use vials for multiple patient use. Single-use vials should only be used for one patient and one procedure, with new, clean needles and syringes. All vials and syringes should be wasted and discarded at the end of the procedure.  To some nurses, this can be an issue especially when there’s still medication left in the vial. Do not combine leftover contents for later use. Consider the disposal of the remaining medication as a safety step, rather than a waste of resources.

Always use a clean needle and syringe with each use of a multi-dose vial. Discard any unmarked vials, opened single-use vials, or multi-dose vials that have not been labeled appropriately. Always check vials for the manufacturer’s expiration date, if before the revised date (sooner than 28 days), then the sooner date is to be used. The only exceptions are vaccines, for which the CDC allows the use of the manufacturer’s expiration date.

If you’re wondering, like me who was taught that multi-dose vials have a 30 day expiration, where does the 28 day expiration comes from?   The answer courtesy of pharmacy friend on twitter @jfahrni is from the USP <797>. The Multiple-dose Containers Section of USP Chapter <797> states that the “BUD for an opened or entered (e.g., needle-punctured) multiple-dose container with antimicrobial preservatives is 28 days (see Antimicrobial Effectiveness Testing <51>), unless otherwise specified by the manufacturer.”

References:

1. Multi-dose vials: Multiple Compliance Targets. http://www.hospital-accreditation.com/?p=495

2. USP <797>

3. Label (and picture) from Healthcare Logistics. http://bit.ly/df9N3v