Critical patient safety alert issued over lack of epidural bags

The patient safety alert said a range of alternative licensed and unlicensed bags, which include unlicensed imports, are still available during the shortage period, but the use of those products requires a “co-ordinated trust-wide approach”.

A patient receives an epidural — The patient safety alert applies to acute care hospitals and any other organisations providing procedures that require epidural infusions

A “safety critical and complex” national patient safety alert has been issued regarding epidural bag supply issues, which are expected to last until at least March 2026.

The patient safety alert, issued on 2 December 2025, has outlined problems affecting the supply of epidural bags from Sandoz (licensed) and Fresenius Kabi (unlicensed), containing bupivacaine only, bupivacaine and fentanyl, as well as levobupivacine and fentanyl.

It said that a range of alternative licensed and unlicensed bags — including unlicensed imports — are available during the affected period.

However, the use of these products will require “a co-ordinated trust-wide approach to ensure safe implementation”, it said.

“Preparing epidural infusions in clinical areas using individual components poses a significant patient safety risk from calculation, measurement and preparation errors, resulting in incorrect dosing and microbial contamination,” the alert said.

“Preparation in clinical areas should only be considered if all other options, including switching from epidural to other routes of analgesia, have been considered and ruled out.”

The patient safety alert applies to acute care hospitals and any other organisations providing procedures that require epidural infusions.

It also states that implementation should be co-ordinated by an executive lead (or an equivalent role in organisations without executive boards) and supported by clinical leaders in pharmacy, theatres, anaesthesia, maternity care and critical care.

It has asked for a list of actions to be completed by 12 December 2025, which includes the establishment of a working group chaired by a lead anaesthetist, where a pharmacy representative liases with the medicines procurement team, as well as a review of how products are used and confirmation of current stock to establish the impact of the supply issue.

The alert also calls for the agreement of a trust-wide action plan for the use of alternative products.

It adds that up-to date-supply information for all affected products is available on the Specialist Pharmacy Service Medicine Supply Tool.

Additional clinical guidance to support local decision-making is being drafted by NHS England, which will be disseminated to all trusts “in the coming week”, the alert says.

In a l etter published on 2 December 2025, the Scottish government asked directors of pharmacy to forward the alert to chief pharmacists and hospital pharmacists.