Recognizing the potential magnitude...

Recognizing the potential magnitude and seriousness of medication errors in the and other perioperative settings, AORN unraveled a guidance statement to assist clinicians in developing and implementing policies and courses related to safe medication practices in the OR and other areas where surgical and other invasive conducts may be performed. This document was make knowned collaboratively by the Research Department and the Center for Nursing Practice at AORN and approved through the AORN Board of Directors. It first was published in the May 2002 AORN Journal The guidance statement has been reviewed and updated at the Presidential Commission on Patient Safety to mirror current safe medication practices in 2004

PREAMBLE

The intention of this guidance statement is to provide a framework from which practitioners can evolve 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 surgical and other invasive operations may be performed. In this document, the spell OR is meant to be inclusive of all perioperative practice settings.

A sample protocol is quick in emergenciesed with the understanding that it ultimately is a facility's responsibility to unfold and implement defined practice protocols specific to its individual practice setting. Information regarding safe medication practice is evolving by means of national research initiatives. Practitioners should review just discovered information as it becomes available and use it to evolve evaluate, and revise their policies and courses for safe medication use in the OR. Health care facilities should disentangle an organizational philosophy toward medication errors from a viewpoint of "system failures" and of seeking "system solutions" to impede these errors.

GUIDANCE STATEMENT

Health care facilities should identify in policy which tribe and/or job categories may participate in medication management and administration. Facility policy for safe medication practice should be based forward the five "rights" of medication use, 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 imagination to be appropriate.

Health care facilities should unfold standardized procedures for safe medication practices in the OR. simple bodys of safe medication practices should include, nevertheless not be limited to, specification of systems for

* verifying medication labels;

* delivering medications to the sterile field;

* labeling medications forward and off the sterile field;

* confirming labeled medications in succession the sterile field;

* communicating medication, force and dosage as the medication is passed to the living body who will administer it;

* establishing dose limits; and

* monitoring patients for adverse medication reactions.

All original medication and solution containers and delivery devices should remain available for regard 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 manner of proceedings Facilities should implement processes for validating on a regular basis.

* performances should be developed for reporting and responding to medication errors and near misses, as well as reviewing sweeps 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 it difficult to make a medication error. 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 it impossible to make a medication error. Examples of forcing functions include removing certain medications (eg cytotoxic agents, concentrations of saline higher than 09%) from the OR.

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

* Medications should be stored safely with consideration given to separation of "look-alikes" and "sound-alikes." (1) High-risk/ problem-prone medications should not be stored alphabetically. Whenever possible, label storage areas with the medications' generic and brand names.

* popular and reliable medication reference materials should be readily available to practitioners 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 containers' eases to the sterile field.