Take a hard look at how medications are managed in your facility. Is there a standardized way to ensure the correct drugs and the right doses are given? Are you properly labeling every syringe? Are you confident that controlled substances aren't being diverted? If you hesitated when considering your responses, read on to learn how smart storage solutions, prefilled syringes and barcode technology have the potential to keep drugs secure and your patients safe.

Accurate administration

Anesthesia providers who prepare and label syringes for a case are often the ones who administer the medications during surgery, meaning often there are no protocols or policies in place for an independent doublecheck to ensure the correct medication or dose is prepared and given. Errors are also caused by incomplete or non-standardized syringe labeling, which increases the risk of misidentifying drugs and dose strengths.

The variability of surgery can also contribute to medication mishaps. Some anesthesia providers fill syringes with more than the required dose with the intention of administering incremental amounts based on how the patient responds to each push. That practice increases the risk of giving an incorrect amount. The ability of anesthesia providers to react quickly to symptoms of adverse events caused by medications they administer might also contribute to an underreporting of medication errors. (If patient harm is adverted, did an error occur?)

Medication safety technology can greatly reduce the incidence of errors when integrated into an overall care approach. For example, automated dispensing anesthesia carts help ensure that providers have access to the correct drug for administration. Additionally, point-of-use barcode scanners provide audio and visual confirmation of scanned drugs, automatically generate accurate and legible labels you can affix to syringes, and track the medications used during cases.

Prefilled syringes are another medication safety upgrade worth considering. They feature easy-to-read, color-coded (based on drug class) labels that clearly note the medication's name, concentration and expiration date. That's more information than anesthesia providers often note on handwritten labels. Because the medications come ready to administer and, in some cases, in dose-appropriate amounts, prefilled syringes also reduce the waste you'll need to dispose of at the end of the case.

There are more practical ways to help ensure your team prepares and administers the correct medications. Limit the types and quantities of medications in the perioperative area to those that are needed for the day's cases. Also, constantly assess your medication use in order to streamline supplies. That way, you'll stock only often used and needed medications in anesthesia workspaces, automated dispensing cabinets and drug storage carts.

Security measures

Controlled substances are commonplace in the OR and are easily diverted if you don't have systems in place to carefully monitor their use and keep them secured until immediately before the case during which they're needed.

Locking anesthesia carts electronically control access to drugs and can track — thanks to provider-specific passcodes or keycards — who accessed medications. More basic double-locking carts also help secure controlled substances; one key provides access to standard medications, while the other unlocks the drawer containing the drugs to which you want to limit access.

Automated dispensing cabinets provide more advanced drug monitoring. The cabinets record the the time the medication was accessed, the exact amount that was removed and the amount that was returned or wasted after a case. You can check the records to see if the amount of medication documented as administered during the case matches the amount used or wasted.

Automation provides a more complete and detailed tracking of medication movement than the manual tracking of controlled substances, but no system, even a high-tech one, is failsafe in eliminating all risks for diversion. Luckily, there are steps you can take to limit the amount of controlled substances circulating through your facility.

First, keep automated dispensing cabinets in a secure area with limited foot traffic. Also try to ensure the cabinets are located as close as possible to the ORs or within each room, so anesthesia providers and staff members aren't tempted to pull medications for more than one case, a practice that increases the amount of time medications are unsecure and available for diversion.

To safeguard and protect against diversion, minimize the amount of leftover medication that needs wasting — here's where prefilled syringes can again prove beneficial — and eliminate leftover amounts as soon as possible after cases end. It's tempting — and often more practical — to hold onto leftover amounts of controlled substances until a witness is available to verify that proper wasting takes place. But the significant amount of time that could pass before a witness becomes available could provide staff members with unmonitored access to the leftover medications and additional opportunities to divert the substances.

You must have a process in place that ensures your surgical team is accountable for properly wasting leftover amounts of controlled substances. Make sure excess amounts are wasted as soon as practically possible after cases end. The wasting of controlled substances by one member of the surgical team should be witnessed by a second team member. Both staff members involved should sign off on the amount of drug that was wasted.

Don't underestimate what providers who are battling addiction will do to get their next fix. Drug diverters have been known to look for trace amounts of medications in syringes or vials tossed into conventional disposal containers. Controlled substance waste receptacles, which increasing numbers of facilities are adding to perioperative areas, improve the safety of disposing waste by deactivating or binding the medications to render them unusable.

It's best to place these specialized disposal containers in high-traffic, high-visibility locations or areas close to where controlled medications are stored or administered for ease of use. When used properly, the receptacles provide a mechanism for staff to efficiently process medication waste at the point of care.

In your hands

Medication safety in the surgical setting is improving. Technological advances, such as barcode verification, are helping to prevent errors from reaching patients. Still, more developments are needed to ensure technology can be applied seamlessly into the work environment of the OR, where medications are sometimes needed quickly to treat a patient's rapidly changing condition. Until high-tech solutions can be fully relied upon to improve medication safety, it's your responsibility to limit the risk of human error in drug preparation and administration. Support your surgical team by enacting policies that make medication mistakes less likely and invest in products that help ensure they give the right dose of the right medication to the right patient at the right time. OSM