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All local anaesthetic solutions should be stored separately from intravenous infusion solutions, to reduce the risk of accidental intravenous administration of such drugs.^24,34

Drug labels should be used to identify syringes and infusions that contain medications.^24,35 A robust system of communication between the anaesthetists, nursing staff and proceduralists, including confirmation of medications, should be in place to avoid miscommunication and miscalculation errors.²⁸

Local guidelines should consider mitigating the risk of drug overdose for drugs that are available in different strengths. Stocking medications in only one strength (e.g., ketamine and midazolam) can decrease the incidence of medication errors.

Prefilled syringes supplied by the pharmacy should be considered, especially in areas where anaesthesia is delivered in an emergency.³⁶

Where necessary, premedication or sedation should be considered for patients with additional needs, including those with extreme anxiety.⁴³

Where possible, reasonable adjustments to processes and environments should be made to reduce anxiety and avoid the need for elaborate premedication of patients. Such adjustments may include admission directly to the procedure room, wearing outdoor clothes, and/or not performing observations.^43,44

All patients with complex needs should have a suitable preoperative assessment and multidisciplinary planning and an anaesthetist should be involved in the best-interest discussions regarding individual risk.^43,45 Learning disability liaison teams or equivalent should be involved early in care planning.

Consideration should be given to providing additional flexibility in the timing of lists to allow adequate time for patients with learning disabilities.^43,45

Where it is offered, policies should be in place for home sedation for patients who will not leave their homes, in conjunction with the ambulance service. This should involve a risk assessment, a detailed plan and emergency contingencies.^44,45,46

Policies should be in place for in-car or entrance-hall sedation for patients who will leave home but who have difficulties entering the hospital environment.⁴⁵