Look around your facility. Can you spot the exhausted nurse who's about to administer the wrong medication to the 6-year-old patient? Did you know your anesthesia tech just swiped a vial of fentanyl to feed his hidden drug addiction? Of course not, but the following technologies can provide you some peace of mind by keeping your medications organized and secure, and by helping to ensure the right dose is administered to the right patient at the right time.

1. "Smart" IV pumps

Newer IV pumps contain a library of your facility's drugs and can be programmed with hard and soft limits, which reduce errors associated with the manual programming of pumps, says Michelle Mandrack, MSN, RN, director of consulting services at the Institute for Safe Medication Practices (ISMP) in Horsham, Pa.

The limits built into the drug library help you recognize a potential error if you accidentally put in a rate or dose that exceeds the preprogrammed limits, explains Ms. Mandrack. However, there are some common errors that can still occur with these devices. You still have to manually go through the device's library and choose the correct medication. You then have to input the dose and rate by hand.

"There are now systems available in which 'smart' pumps are integrated with the EMR," says Ms. Mandrack "In these systems, the electronic medication order containing the infusion parameters is verified by pharmacy and then, through barcode scanning, pre-populated in the smart pump." The systems ensure that the correct information is sent to the smart pump, which then sends information back to the EMR to document intake and how much medication is being used.

2. Automated dispensing cabinets

These are great devices that allow medications to be stored and dispensed near the point of care. "I see these devices in many hospital ORs and believe they also have a place in standalone outpatient facilities," says Ms. Mandrack.

There are 2 main types of automated dispensing cabinets available: profiled and non-profiled. Profiled cabinets are equipped for two-way communication with a facility's pharmacy; when medication orders are entered, pharmacists review and approve the medications. The catch here is that you can't access medications until orders has been approved, so nurses may have to wait to select and administer the medication to their patients. Non-profiled cabinets do not require a pharmacist's review and approval of ordered meds, so a nurse would not have to wait to administer doses. However, that means you lose the additional level of safety provided by pharmacist verification, points out Ms. Mandrack, who says ISMP strongly advocates for the use of profiled automated dispensing cabinets.

The cabinets come with a variety of security features designed to improve patient safety. All have a display screen where you scroll through to find the patient's name. Once you select the correct patient and medication, the drawer containing the drug will open. Some of these automated drawers are matrix style with open slots where medications are stored. It would be the nurse's job to choose the right slot with the correct medication.

"The drawers that are set up with lock-lidded storage pockets provide a much more secure configuration than the open matrix style," says Ms. Mandrack. "As the drawer opens, the pocket with the selected medication is the only one whose lid pops open, so you're much more likely to be accessing the right drug — as long as the cabinet has been stocked correctly."

Automated dispensing cabinets can also come with a small drawer that has a line of pockets, which each have room for a single medication tablet, capsule or vial. Once a medication is selected, the drawer will pop out only far enough to reveal the individual pocket where the medication is stored. The cabinet's computer system is able to keep track of the number of medications you've removed and only opens far enough to reach the medication you need.

You can even get dispensing cabinets for different areas of your facility. There are specialized, automated medication carts for anesthesia providers that store all the drugs they use. These cabinets are more widely adopted in inpatient perioperative areas, but could also be beneficial in outpatient settings that have pharmacy oversight in light of their important safety benefits, adds Ms. Mandrack.

3. Drug disposal systems

It wasn't so long ago that you tossed partially used vials or expired medications in a plastic container that hung on the wall. Newer drug disposal systems destroy excess drugs and render them unusable, which is an important consideration in efforts to prevent your staff from diverting drug waste for illicit purposes.

Disposable containers that contain a chemical to mix with the drugs are still a common way to make them unusable. You place the drugs in the container with the chemical, add water, wait some time and then throw the whole container away. But there are more environmentally friendly options, including a box that mounts to the wall with 2 different ports for pills and liquid medications; an indicator light tells you when the cartridges are full. You need a key to access the cartridges for disposal and if the key is not used, an alarm is triggered. The full cartridge is disposed of through a pharmaceutical waste management company and you can order cartridges in bulk to get a discount.

4. Labeling solutions

You can now place small devices on top of anesthesia carts or medication dispensing cabinets that will automatically print out color-coded labels. The colors reflect the different medications classes as defined by the American Society for Testing and Materials International. The label makers can be pre-programmed with the common procedure types for your ORs. Once you pick the procedure, the machines print out labels for the medications the anesthetist uses for those cases. The fields on the labels are prefilled, so the anesthetist simply affixes the labels to the meds as they're prepped. These label makers are stand-alone or can be integrated with an EMR.

5. Prefilled syringes

The AORN Guideline for Medication Safety recommends using prefilled syringes if they are available to make sure you're giving patients the proper dose of medication in a way that reduces the risks of cross-contamination, says Mr. Burlingame. However, a ISMP survey conducted in 2012 discovered that many nurses were removing the adapters on cartridge-type prefilled syringes or removing the cartridge all together to withdraw the medication through the rubber diaphragm. There were many stated reasons for their misuse of the safety-engineered devices, such as a lack of available syringe holders, being unable to see the volume markings on the prefilled syringe or wanting to dilute the medications for various reasons before administering them to patients. According to the ISMP's Safe Practice Guidelines for Adult IV Push Medications, withdrawing medications from a prefilled syringe could lead to contamination, dosing errors and drug mix-ups. It's best to avoid this practice.

Newer drug disposal systems destroy excess drugs and render them unusable, which prevents staff members from diverting drug waste for illicit purposes.

There are also concerns with the labeling of prefilled syringes. ISMP recently detailed reports of non-standard labeling and look-alike prefilled syringes. Drugs that are compounded or repackaged by pharmacies or outsourcing facilities are not held to the same labeling standards as FDA-approved products. Other compounders may use the same tamper-proof cap colors and syringe sizes for completely different drugs like fentanyl and hydromorphone. Even with tall-man lettering and different drug names, the syringes look physically identical — which can cause confusion if someone is in a hurry.

6. Barcoding

In order to get the most out of a lot of these technologies, you should implement barcoded tracking of all your medications. There are many ways that barcoding can help your facility increase its safety standards. On the medication administration side, scanning barcoded medications and barcoded patient ID bracelets helps ensure you're giving the right drug to the right patient at the right time. A barcoding tracking system can also be set up with alerts that let you know if, for example, you're about to administer a medication at the wrong time.

In the future, barcoding will help reduce errors when smart pumps are integrated with EMRs. In this scenario, the patient, IV medication and smart pump will be scanned to populate the fields of the pump with the infusion parameters instead of you having to manually program the parameters. OSM