Five updates.
One safer acute take.

SAFETY ALERTCLINICAL NUTRITIONNEW · 13 DAYS

Use an in-line filter for every parenteral nutrition infusion

What changedThe MHRA now advises that an appropriate in-line filter should be used whenever parenteral nutrition is administered, in every care setting. Unfiltered administration has been linked to incidents including a fatal embolism.

WHY IT MATTERSAcute units receive and transfer patients on PN, and the filter is a final bedside defence against air, particulates and precipitates.

DO DIFFERENTLYBefore starting or continuing PN, confirm that the giving set includes the filter specified for that formulation and route.

SAFETY ALERTENDOCRINOLOGYRECENT · JUL 2026

Domperidone is now contraindicated in suspected phaeochromocytoma

What changedMHRA product information now contraindicates domperidone in confirmed or suspected phaeochromocytoma after reports of severe hypertension. An episode of severe hypertension while taking it can unmask the diagnosis.

WHY IT MATTERSDomperidone may be given for nausea before an acute hypertensive presentation is fully understood.

DO DIFFERENTLYStop domperidone and use an alternative if phaeochromocytoma is confirmed or suspected; investigate the diagnosis if severe hypertension occurs on treatment.

SAFETY ALERTINFECTIOUS DISEASESACTION DUE · NOV 2026

Check that ‘penicillamine allergy’ is not a misrecorded penicillin allergy

What changedA National Patient Safety Alert warns that look-alike selection errors can leave a true penicillin allergy recorded as penicillamine allergy, risking fatal anaphylaxis. Organisations have until 20 November 2026 to complete the required actions.

WHY IT MATTERSThe acute take is where an incorrect allergy record can immediately lead to penicillin exposure during empiric treatment.

DO DIFFERENTLYReconcile and correct allergy status on admission and discharge; treat an unexpected penicillamine-allergy entry as a prompt for clinical verification.

CURRENT UK PRACTICEINFECTIOUS DISEASESCURRENT · NOV 2025

Moderate-risk sepsis plus hypoperfusion should be managed as high risk

What changedNICE NG253 defines suspected infection with NEWS2 5–6 as moderate risk, but says evidence of hypoperfusion—such as lactate above 2 mmol/L or acute kidney injury—moves the patient into the high-risk pathway.

WHY IT MATTERSA moderate NEWS2 can understate risk when lactate or renal injury shows organ hypoperfusion.

DO DIFFERENTLYActively check for hypoperfusion in moderate-risk patients and escalate to the high-risk sepsis pathway when it is present.

CURRENT UK PRACTICECARDIOLOGYCURRENT · 2025 GUIDELINE

For refractory VF, change the pad vector after three failed shocks

What changedRCUK 2025 puts greater emphasis on correct lateral pad placement and advises considering a fresh antero-posterior set after three failed shocks. Routine dual sequential defibrillation is not recommended.

WHY IT MATTERSAcute physicians often lead or join arrests where pad position and the next step in refractory VF are immediately actionable.