Your Practice: 3 Medication Safety Risks & Solutions to Support Safer Surgery

Medications administered in the OR are an essential piece of achieving optimal surgical outcomes. Consider how compounded wound irrigation fluid can support incision healing and reduce infection risk. And chemotherapeutic agents administered during surgery have been proven to successfully target aggressive cancers.

However, the benefits of medications administered in the OR also bring significant safety risks, such as occupational exposure to hazardous medications that damage DNA and risk fetal abnormalities, notes AORN Senior Perioperative Practice Specialist Julie Cahn, DNP, RN, CNOR, RN-BC, ACNS-BC, CNS-CP. She’s the lead author of the updated Guideline for Medication Safety that publishes electronically this month in eGuidelines+.

Cahn gave us an inside look at three major medication safety risks threatening surgical staff and patients and the specific evidence-based recommendations she included in the updated medication safety guideline to reduce and prevent these dangers.

Risk #1:

Chromosomal damage and DNA damage, known as genotoxicity, has been documented in healthcare workers who are exposed to hazardous medications such as chemotherapy agents. This occupational exposure also causes a high risk for adverse reproductive outcomes.

Safety Updates: Studies show that nurses who handle chemotherapy medications DON’T always follow protective measures to prevent this dangerous exposure, so more specific recommendations for correct use of personal protective equipment (PPE) when handling hazardous medications have been added (Recommendation 12):

• You should always wear goggles and single-use face shields, a disposable gown of the highest liquid barrier performance a disposable gown of the highest liquid barrier performance class, and two pairs of chemotherapy gloves, with gown and glove change when needed per guideline recommendation.
• If you are exposed to vapors or cleaning large spills of hazardous medications, you should wear a full-face piece, chemical cartridge-type respirator or powered air-purifying respirator (PAPR).
• When you are not at risk for exposure to hazardous medication aerosols, select either respiratory protection or a surgical mask based on the hazardous medication safety plan, procedure to be performed, medication administration processes, and the perceived risk for exposure.

Risk #2:

Patient injuries and deaths have been linked to compounded medications that are contaminated or contain inconsistent amounts of ingredients that are thousands of times stronger than labeled.

Safety Updates:Your facility should procure compounded medications from a manufacturer or from an FDA-registered outsourcing facility, when possible. (Recommendation 3)

Solutions like saline compounded with a drug such as heparin should be prepared by your facility pharmacy personnel when the compounded drug cannot be obtained from a manufacturer, FDA-registered outsourcing facility, or compounding pharmacy. (Recommendation 10.3)

Risk #3:

Adverse patient events have been linked to workarounds and alert overrides with automated medical administration technology.

Safety Updates: Your facility should use automatic dispensing cabinets, bar code scanning, and smart infusion pump technology, when possible AND you and your team members using these technologies should be directly observed to determine if clinical practice is:

• Consistent with the manufacturer’s IFU
• Compliant with your health care organization’s policies and procedures
• Experiencing barriers such as defective equipment or inaccessible wristband, and
• Using overrides or workarounds. (Recommendation 16.7)

Updated Resources Coming 3/16/23

Look for updated resources coming this month to improve medication safety in eGuidelines+, including:

• Revised Guideline for Medication Safety
• Updated Competency Verification Tools
• Key Takeaways highlighting new and updated practices
• Updated Policy and Procedure Template for medication safety
• A webinar with Cahn discussing the rationale behind the guideline updates