Safe medication management is founded on proper drug handling, from storage to preparation to delivery. The rules of drug administration have been clearly established by regulatory agencies and professional organizations. They should inform your facility's best practices, as any breaches in them can impair patient safety. Take a look at the photos on the next few pages and see if you can determine what's gone wrong in each one. Then read on to see how the situation should be remedied. You might also want to review your staff's medication handling practices to make sure these types of errors aren't putting your patients at risk.

What's wrong? This "indefensible error" of disorganization is courting a catastrophe. The casual intermingling of different drugs in the same bin, tray or cart drawer can easily cause avoidable errors.

The remedy: Separate compartments in storage areas are a necessity, as is the assurance of proper segregation by the staff who stock your medications.

What's wrong? Note the drawn, but insufficiently labeled, syringe. It's missing several of the 5 required elements of syringe labeling, which include the drug's name and strength, the date and time it was drawn, and the preparer's initials. (Note that the syringe is also intermingled with other drugs in a common container.)

The remedy: Drugs removed from their original identifying containers must be labeled. In spite of the evidence presented in this photo, preprinted labels make this more likely to happen than blank ones do.

What's wrong? Sterile products that weren't prepared in a hood must be used within an hour of preparation. It's unlikely that all these products will meet that deadline.

The remedy: The compounds should be prepared and labeled as needed, not en masse. Or consider pre-mixed antibiotic options that can be easily deployed on an as-needed basis.

What's wrong? A lot, actually. The drug is unidentified, and drawn syringes — even if properly labeled — should be drawn as close to the time of administration as possible. These syringes, which probably contain propofol (but we don't know for sure, do we?), may or may not also contain lidocaine and likely won't all be used within the hour. Plus, the contents may have been drawn from single-use-only vials, so knowing their origins is key to patient safety compliance.

The remedy: Educate the staff on labeling and safe injection practices, specifically with regard to the timing of drawing and use.

What's wrong? The pre-spiked bags are labeled with the date and time of spiking, which is good news, but are all those bags going to be used within 1 hour? If not, it's a breach of medication safety rules.

The remedy: Staff education. This type of "over-efficiency" can adversely impact medication safety and breed supply waste.

What's wrong? Unlabeled tablets for administration to patients at an unspecified later time goes against everything you should have learned in Nursing 101.

The remedy: Train your staff that unless the doses are given immediately, all drugs must be identified.

What's wrong? Simple: This is not by any stretch of the imagination the right way to identify a syringe's contents.

The remedy: Use a properly completed syringe label, containing the information described above.

What's wrong? This is a single-dose vial. The fact that an expiration date sticker has been placed on it suggests that multiple uses are planned.

The remedy: A vial's size or a drug's shortage may tempt multiple use, but reinforce to your staff that a single dose means a single use, no exceptions.

What's wrong: A look-alike, sound-alike error caused by this misplaced drug would have serious consequences.

The remedy: Minimize the risk of mix-ups by clearly separating easily confused drugs in storage areas, labeling them with "tall man" letters, and training your staff with the Institute for Safe Medication Practices' risk-reduction tools (http://www.ismp.org/Tools/default.asp).

What's wrong? There are 2 strengths of the same drug in this common bin, potentially setting up a medication error.

The remedy: If you must stock more than 1 strength of a drug, make sure they are carefully separated. And remember to always write down verbal drug orders and read them back to the prescriber for confirmation.