Medication Management

Get clinical answers to frequently asked questions about Medication Management.

  • How should medications on the sterile field be labeled?

    The medication label should state (at a minimum) the following, in accordance with the health care organization's policy:

    Medication name,
    Strength, and
    Concentration

    Resources:

    Recommended practices for medication safety. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:255-294.
    2013 National Patient Safety Goals. The Joint Commission. http://www.jointcommission.org/patientsafety/nationalpatientsafetygoals/. Accessed December 7, 2012.

    Updated January 28, 2013

  • Does a medication that is immediately administered to a patient (eg, pain medication) require labeling?

    No. An immediately administered medication that is prepared or obtained, taken directly to a patient, and administered to a patient without any break in the process by the same person does not require labeling.

    Resources:

    Recommended practices for medication safety. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013:255-294.
    2013 National Patient Safety Goals. The Joint Commission. http://www.jointcommission.org/patientsafety/nationalpatientsafetygoals/. Accessed December 7, 2012.

    Updated January 28, 2013

  • Has propofol been classified as a controlled substance?

    Presently, propofol has not been classified as a controlled substance despite concerns regarding drug diversion and supply shortages. The American Society of Anesthesiologists (ASA) sent a letter to the Drug Enforcement Agency (DEA) in December 2010 supporting the scheduling of propofol as schedule IV. As of December 2012, propofol is not scheduled under the Controlled Substances Act, although it is listed as "Drugs and Chemicals of Concern".

    Resources:

    ASA submits letter to DEA supporting the scheduling of Propofol. American Society of Anesthesiologists (ASA). December 23, 2010. http://www.asahq.org/For-Members/Advocacy/Washington-Alerts/ASA-Submits-to-DEA-Supporting-the-Scheduling-of-Propofol.aspx. Accessed December 7, 2012.
    Drugs and Chemicals of Concern: Propofol (Diprivan). Drug Enforcement Agency (DEA). January 2010. http://www.deadiversion.usdoj.gov/drugs_concern/propofol.htm. Accessed December 7, 2012.

    Updated January 28, 2013

  • Who should fill pain pumps: the pharmacist or scrub personnel at the sterile field?

    Pain pump reservoirs should be filled by a pharmacist with exception of urgent situations.Personnel filling a pain pump with medication should follow the manufacturer’s instructions for use, local, state, and federal regulations, and United States Pharmacopeia (USP) chapter <797>. The reservoir should be filled in a sterile environment such as under a laminar airflow hood.

    Resources:

    Van Wicklin, SA. Filling pain pump reservoirs. [Clinical Issues]. AORN Journal.2012;96(5):547-549.

    Updated January 28, 2013

  • What is the correct procedure for receiving verbal medication orders in the perioperative setting?

    The National Coordinating Council for Medication Error Reporting and Prevention recommends that all verbal orders be converted to written orders and signed by the individual receiving the order. Verbal orders should be documented in the patient's medical record and reviewed and countersigned by the prescriber as soon as possible. Record the order on either the regular physician's order form or perioperative record according to facility policy and procedure.

    The following steps can be taken to guide safe medication practices when taking verbal orders:
    • Develop a read-back system that includes verbalizing the read-back digit-by-digit (e.g., one-five, not fifteen).
    • Allow only licensed health care providers to receive verbal orders.
    • Consider using a visual tool to enhance communication (ie, dry erase board).
    • Limit distractions and interruptions.
    • Record the order on the patient medical record as soon as possible.
    • Question prescribers when there are any concerns or clarification is needed about verbal orders.

    Resources:

    • Recommended practices for medication safety. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013;255-294.
    • Recommendations to reduce medication errors associated with verbal medication orders and prescriptions, February 24, 2006. National Coordinating Council for Medication Error Reporting and Prevention. http://www.nccmerp.org/council/council2001-02-20.html. Accessed November 20, 2012.
    • Hendricksen T. Verbal medication orders in the OR. AORN J. 2007;86(4):626-629.
    • Record of care, treatment, and services. In: Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations;2010:RC-1-RC-13.

    Updated January 28, 2013.

  • Who is authorized to receive and record verbal orders in the perioperative setting?

    Authorization is given according to facility policy and state and federal regulations such as the nurse practice act. The Joint Commission (JC) and Centers for Medicare and Medicaid Services (CMS) requirements state facility policy and state and federal regulations must be followed regarding who is authorized to receive and record verbal orders.

    Resources:

    • Recommended practices for medication safety. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2013;255-294.
    • Recommendations to reduce medication errors associated with verbal medication orders and prescriptions, February 24, 2006. National Coordinating Council for Medication Error Reporting and Prevention. http://www.nccmerp.org/council/council2001-02-20.html. Accessed November 20, 2012.
    • Hendricksen T. Verbal medication orders in the OR. AORN J. 2007;86(4):626-629.
    • Record of care, treatment, and services. In: Comprehensive Accreditation Manual for Hospitals. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations;2010:RC-1-RC-13.

    Updated January 28, 2013.