Recognizing the potential magnitude...

Recognizing the potential magnitude and seriousness of medication errors in the OR and other perioperative settings, AORN has bring outed a guidance statement to help clinicians cause to grow and implement policies and transactions related to safe medication practices in the OR and other areas where operative and other invasive steps may be performed. This document was exhibited collaboratively by the Research Department and the Center for Nursing Practice at AORN and approved by the agency of the AORN Board of Directors.

Preamble. The sense of this guidance statement is to provide a framework from which practitioners can unfold and implement policies and conducts for safe medication management and administration in perioperative practice settings. These settings include traditional ORs, ambulatory surgery units, physicians' offices, cardiac catheterization suites, endoscopy suites, radiology departments, and all other areas where operative and other invasive processs may be performed. In this document, the expression OR is meant to be inclusive of all perioperative practice settings.

A sample protocol is instanted with the understanding that it ultimately is a facility's responsibility to disclose and implement defined practice protocols specific to its individual practice setting. Information regarding safe medication practice is evolving by the and of national research initiatives. Practitioners should review recently made known information as it becomes available and use it to unravel evaluate, and revise their policies and measures for safe medication use in the OR. The health care facility should unfold an organizational philosophy toward medication errors from a viewpoint of "system failures" and of seeking "system solutions" to hinder these errors.

GUIDANCE STATEMENT

Health care facilities should identify in policy which commonalty and/or job categories may participate in medication management and administration. Facility policy for safe medication practice should be based in succession the five "rights" of medication usage, including

* the right patient,

* the right medication,

* the right dose,

* the right time, and

* the right route

Facility policy should define responsibility for questioning any medication order not idea to be appropriate.

Health care facilities should exhibit standardized procedures for safe medication practices in the OR. constituents of safe medication practices should include, if it were not that not be limited to, specification of classifications for

* verifying medication labels;

* delivering medications to the sterile field;

* labeling medications in succession and off the sterile field;

* confirming labeled medications upon the field; and

* communicating medication, hardness and dosage as the medication is passed to the one who will administer the medication.

All original medication/solution containers and delivery devices should remain available for respect in the OR until the conclusion of the procedure

RISK REDUCTION STRATEGIES

* Health care facilities should provide OR personnel with appropriate and timely education related to medication safety actions Facilities should implement processes for validating on a regular basis.

* deeds should be developed for reporting and responding to medication errors and near misses, as well as reviewing tendency s with a focus on error reduction instead of punishment.

* Work schedule requirements in surgical settings should be modified to minimize the risk of fatigue-induced errors.

* Constraints or forcing functions should be used to minimize risks related to medication management and administration. Constraints are approaches that make a medication error difficult. Examples of constraints include dose limit protocols, automatic stop orders, triple checking medications, and labeling all medication containers in the OR. Forcing functions are approaches that make a medication error impossible. Examples of forcing functions include removing certain medications (eg cytotoxic agents, concentrations of saline above 09%) from the OR.

* Automatic medication processe and dosage calculations should be used when possible.

* Medications should be stored safely.

* common and reliable medication reference materials should be readily available to the practitioner in the OR.

* Manufacturers should be encouraged to use distinctive labels for medications and solutions used in health care.

* Manufacturers should be encouraged to provide medications and solutions in ready-to-use or ready-to-administer containers that will allow for sterile delivery of the container contentments to the sterile field.

SAMPLE PROTOCOL FOR SAFE MEDICATION HANDLING AND ADMINISTRATION IN THE OR

* Verify medication orders according to facility policies. Verify any medication listed forward the physician's preference list with the physician before delivery to the sterile field and/or administration.

* Confirm all verbal orders through repeating the complete order using a digit-by-digit technique for dose (ie, one-two not twelve) and recording the order in the patient's record as easily as feasible. Only physicians and/or RN should receive verbal orders. Document medication orders according to facility policy.