No one knows how often medication errors happen. A few studies suggest they're frighteningly frequent, but as long as we rely on an honor system of self-reporting — and point fingers at those who confess — we can guess that vast numbers of errors are going to continue going unreported. People who fear reprisals or punishments aren't likely to own up every time something happens.

Medication errors happen, in part at least, because, as we all know, the operating room is a very complicated place. We're surrounded by equipment and noise, and often the room is dimly lit. It's also a high-stress environment, which increases the potential for errors. But I'd bet that in many cases, very similar types of drug errors may be occurring again and again within the same institution, and that relatively simple solutions exist to correct at least some of those errors — if only they were reported. As such, we should be encouraging reporting in a blameless society, so we can do root-cause analyses and implement the solutions we need.

For several years, the Anesthesia Patient Safety Foundation has advocated using point-of-care scanners to confirm and document every drug administration. So far, a relatively small number of facilities have adopted that approach, but many seem to be moving in that direction.

Meanwhile, it's a little shocking how few providers are aware of USP-797 and its implications on point-of-care drug compounding. USP- 797, the only chapter of the U.S. Pharmacopeia that applies to individuals compounding drugs, makes it very clear: Except in emergencies, syringes should be filled only in a sterile environment under a laminar flow hood. So the trend toward prefilled syringes is a big step in the right direction. Not only are they USP 797-compliant, but they also have a very long shelf life, typically 30 to 45 days. While they may cost a little more upfront, in the long run they're likely to save money, because they waste less medication.

PREPARED OR PREFILLED? If you draw up a medication and don't use it within 1 hour, you must discard it. On the other hand, prefilled syringes have a long shelf life, typically 30 to 45 days.

Most syringes are also bar coded and use "tall man" lettering, which makes drug identification easier at a glance. Those added layers of protection are important developments. Bar coding permits point-of-care scanning and confirmation of every drug administered, as well as the ability to document. It's worth noting, too, that any drug that's going to run as a continuous infusion should always be prefilled by your pharmacy or by an outsourced compounder.

Point-of-care printing eliminates legibility issues and forces you to include your name, the time, the expiration time and all other required information, but it can also suggest that drug-mixing at the point of care is happening, which, as noted, should be minimized, if not eliminated.

It also helps to standardize both the drugs and the concentrations you use, as much as possible. Error rates are much higher when busy nurses at the point of care are being asked to customize each drug and each dose. Brightly highlight outliers (atypical drugs and atypical doses).

Your policies and procedures that govern drug safety must be accompanied by staff education. If you say you're going to put an end to point-of-care compounding because the risks are too steep, make sure the whole OR team is on the same page. OSM

Ansell
Sandel Medication Labeling System
ansell.com/sandel
(866) 764-3327
FYI: Ansell's kits, which can be customized to meet facility needs, include everything needed to mark and label medication on and off the sterile field, including medication labels and cups, markers and identification flags. The labels are compliant ?with The Joint Commission's Universal Protocol and are moisture- and smear-resistant, so they won't fall off when exposed to water, says the company. You can apply the proprietary ID flags to stainless steel basins, med cups and glass cups.

CAPS
Prefilled Anesthesia Syringes
capspharmacy.com
(800) 853-6498
FYI:: CAPS offers a broad line of pre-filled anesthesia syringes with tamper-evident caps that are designed to meet The Joint Commission's Medication Management Standards and National Patient Safety Goals for medication labeling. Standardized bar-coded labels with "tall man" lettering and ASTM color differentiation by drug class help identify drug groups and draw attention to look-alike/sound-alike medications. Additionally, the company's "test, hold and release" program ensures compliance with Current Good Manufacturing Practice standards for sterility, potency and endotoxin testing before products are released and shipped.

Codonics
Safe Label System 500i
codonics.com
(800) 444-1198
FYI:: One quick swipe of a vial or ampoule, and the Safe Label System, with its bar code technology, immediately identifies drugs both visually and audibly, and automatically produces a Joint Commission-compliant label. Meanwhile, it records the NDC (National Drug Code), which can improve charge capture and, by automatically updating inventory, help reduce outages. System-prepared syringes, once administered, can be scanned into an EHR or anesthesia information management system. The system integrates with anesthesia carts and is designed to eliminate the 3 most common medication errors: vial/ampoule swaps, mislabeling and syringe swaps.

Fresenius Kabi
Simplist Prefilled Syringes
simplist-us.com
(888) 386-1300
FYI: Fresenius Kabi's Simplist pre-filled syringes are bar coded and clearly labeled with large, legible type. They offer a 24-month shelf life to help decrease expired medication waste. Nine drugs in 20 commonly administered dosages are available: morphine sulfate, midazolam, dexamethasone sodium phosphate, diphenhydramine hydrochloride, ketorolac tromethamine, metoclopramide, ondansetron, heparin and Dilaudid. Syringes require no point-of-care preparation and are compliant with Current Good Manufacturing Practices.

KRS Global Biotechnology
Prefilled OR Syringes
krsbio.com
(561) 891-0800
FYI: With "tall man" lettering and color codes based on anesthesia guidelines, KRS Global's prefilled syringes are designed to be easy to identify, reducing the potential for medication errors. They're the only patented color-coded plungers in the acute care market, says the company, and 100% are tested for sterility, endotoxins and potency, while adhering to the Drug Quality Security Act. Available medications include ephedrine, epinephrine, glycopyrrolate, labetalol, lidocaine, neostigmine, phenylephrine, rocuronium and succinylcholine.

Medi-Dose EPS
Identify-A-Bowl
medidose.com
(800) 523-8966
Pricing: $120 (quantity discounts available)
FYI: The Identify-A-Bowl basin helps you quickly identify solutions, and keep them straight, when working in sterile fields in operating and procedure rooms. The basin has a wide horizontal flange (1/2 inch x 3 inches), so it can accommodate labels large enough to be seen by all caregivers present. It holds up to 150 ml of solution, but takes up relatively little space (3 1/2 inches x 4 1/4 inches) on procedure trays. Designed to resist tipping or spilling, it's made from durable 316 stainless steel, so it can be sterilized by ethylene oxide, autoclave or radiation.

MedVantage
IntelliDate
medvantage.org/new-medical-labeling-technology
(800) 743-5078
FYI: A stand-alone medication-labeling system, IntelliDate has an easy-to-use color touchscreen, 2 built-in label printers and a selection of formats to produce medication labels and other commonly used labels on demand. There's no software to install; you just plug it in. It automatically calculates and prints critical data, such as expiration date and time, as well as employee ID information. By eliminating handwriting legibility issues and dating mistakes, it helps ensure that information is always accurate, legible and consistent. Label rolls come in a variety of sizes and colors, and no ink cartridges or ribbons are required.

Metro
Lionville Med Carts
metro.com/healthcare
(800) 992-1776
FYI:: Metro's cart security systems help keep medications organized and safe with a "grabber" locking system that ensures that patient drawers that look locked are locked. Keyless narcotic/storage drawers are double-locked for added security. Optional card readers (bar code, magnetic stripe or proximity) can be added, enabling authorized users to unlock carts with or without PINs. Codes with optional PINs can also be assigned to individuals, allowing authorized users to open drawers without keys. Other features include adjustable cup dispensers, a tilt-out waste bin and optional automatic locking. Compact bodies and wide wheelbases are designed to prevent tipping when the carts are pushed in and out of elevators or rolling on uneven floors.

PharMedium
Prefilled Syringes
pharmedium.com
(800) 523-7749
FYI: PharMedium offers more than 640 unique prefilled syringe service codes in commonly requested single-dosage forms. A patented label design includes "tall man" lettering, large pronounced numbers, and unique shapes to help differentiate drugs and doses. The design also supports the color differentiation of anesthesia syringe medications endorsed by the American Society of Anesthesiologists, as well as the ASTM standard for color differentiation and the Drug Quality Security Act labeling requirements for 503B registrants.

Viscot Medical
Vismark Medication Labels
viscot.com
(800) 221-0658
Pricing: Packages start at $90
FYI: These labels are designed to meet Joint Commission requirements for labeling medications on and off the sterile field. Standard packages include labels for the most commonly used medications, in color or black and white, and Viscot offers free customization. The labels are waterproof, residue-free, tear-free and smudge-free. They adhere firmly to syringes and metal basins, and are easy to remove. Included is a waterproof permanent marker that can be used for surgical site marking.