When utilizing the vial-2-bag adapter (20mm), often times the liquid leaks around the spiked area.This causes a need for an additional vial of medication to be utilized.Education and re-education has been provided to areas with high levels of complaints, including a "tip sheet".This particular product requires the spike to enter the vial precisely in the middle to prevent leaking, however the surrounding cap is flexible, which allows for misalignment and leakage.Several sporadic reports exist to document the issue, however it was noted during nursing competencies that the issue is much larger than what has been documented.Nursing leadership confirms the leakage happens regularly, but that staff accept this as "normal" occurrence.All reports indicate the issue is with the 20mm/blue device.
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