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6 Key Medication Safety Concepts

Publish Date: 5/1/2013

According to FDA, medication errors cause at least one death every day and injure approximately 1.3 million people annually in the U.S. Perioperative professionals must do whatever they can to ensure their patients do not become a statistic. By understanding critical medication safety concepts, perioperative professionals will put themselves in a better position to avoid making such errors and spotting and correcting mistakes when they are made before harm is done to a patient, the community and themselves.

Here are six key medication safety concepts identified by Bonnie G. Denholm, MS, BSN, RN, CNOR, perioperative nursing specialist for AORN, and Sheldon S. Sones, RPh, FASCP, president of Sheldon S. Sones and Associates, a pharmacy and accreditation consulting firm based in Newington, Conn.

1. Medication storage. Improper medication storage is a common cause of medication errors. Intermingling the same drugs but different strengths is an invitation for a medication occurrence with significant negative outcome, Sones says.

"This mistake occurs partly due to our response to drug shortages, which forces organizations to purchase product in different strengths, as well as a failure to place different strengths in each section of anesthesia carts with clear labeling," he says. "Careful attention to different strengths of the same drugs is imperative."

The intermingling of various drugs in common compartments is one of the most common root causes of errors, Sones says. "It is also one of the most frustrating to see," he adds. "A meeting with staff will help resolve this mistake."
It is critical to identify and address potential mistakes due to look-alike/sound-alike (LASA) drugs. For example, one of the most common LASA errors is ephedrine and epinephrine. "The use of tall man letting is one strategy that prevents such error potential," Sones advises. "Using ePHEDrine and EPINEPHrine is a wise, preventive strategy."

Denholm notes that recent evidence indicates standardization of medication storage areas can reduce risk, especially when anesthesia professionals rotate between multiple facilities within the community.

"For example, anesthesia storage carts and emergency medication storage carts should be organized according to order of medication use, frequency of use, similarity of action, severity of harm from misuse and lack of similar appearance," she says. "The storage areas should be set up the same within the perioperative area and, if possible, within the community."

2. Preparation. A general principle for medication safety is that medications should be prepared as close as possible to the time of use, Denholm says.

"This means that unless medications are in pre-filled syringes that are supplied and labeled by the manufacturer or a pharmacist, there should not be any medications that are pre-drawn up and stored on the anesthesia cart or anywhere else (e.g., TB syringes filled with local anesthetic on IV start cart)," she says.

3. Labeling. "From the perioperative perspective, this could relate to medications on the sterile field that have been transferred from the original packaging into a secondary container," Denholm says. "Unless the medication is to be administered immediately, all medications removed from the original package and transferred to a secondary container should be clearly marked and easily identifiable. At a minimum, the secondary container should be labeled with the medication and dose in accordance with the healthcare organization's policy."

Perioperative professionals must make sure to always follow proper labeling practices. The use of preprinted labels that includes basic information, such as strength/potency of the drawn medication, is an easy step to support these efforts, Sones says. But placing a preprinted label on a medication is just the first step.

"It is critical that the writing on the label is legible, and the label needs to be filled out completely," Sones advises. "While you need to include the name of the drug as part of medication labeling, this cannot be the only piece of information included. You need the medication's strength, date it was mixed, time and by whom."

4. Verification. "A medication must never be chosen based on its cap color, bottle color or bottle shape," Sones says. Perioperative professionals must always carefully read the bottle label, and instruct patients when provided medication to do the same.

The importance of verification practices further supports the need for proper labeling. "Not labeling a medication at all because a product is 'recognizable' is never acceptable," Sones says. "Compare propofol and propofol plus lidocaine to see if you can tell the difference visually and you will understand why not labeling a product because it's 'recognizable' should never fly."

5. Disposal. While improper disposal does not directly harm the patient under the perioperative professional's care, it can harm the community "downstream," Denholm notes. "Perioperative professionals should dispose of medications in a manner that does not contaminate the water supply. This can be confusing sometimes if a prescription medication is not labeled as safe for flushing," she says.
"Collaboration with pharmacists is important to determine proper disposal methods or in the case of unused or unopened medications found in medication storage areas, collaborate to determine processes for how to return the medication to the pharmacy," Denholm suggests.

6. Sharps safety. Perioperative professionals cannot protect patients if they are injured on the job. "Statistics indicate that injuries from hollow-bore needles constitute a majority of percutaneous injuries and pose the highest risk of exposure to bloodborne pathogens," Denholm says.

To help prevent these types of injuries, perioperative administrators should establish policies that set a priority throughout perioperative settings to supply safety devices. "These include needleless systems; sharps with engineered sharp injury protection devices; blunt cannulas to withdraw medications and fluids from vials; retractable, protective sheath or self-resheathing systems; and hinged re-cap needles to administer local anesthetics and other injectable medications," she says.


Guidelines for Perioperative Practice


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