1954 Perioperative Medication Safety Practices
1954Perioperative Medication Safety Practices
1954Perioperative Medication Safety PracticesAORN Independent Study ActivityAORN Video with Study GuideDisclaimerAORN and its logo are registered trademarks of AORN, Inc. AORN does not endorse any commercialcompany’s products or services. Although all commercial products seen in this course are expected toconform to professional medical/nursing standards, inclusion in this course does not constitute a guaranteeor endorsement by AORN of the quality or value of such product or of the claims made by its manufacturer.No responsibility is assumed by AORN, Inc. for any injury and/or damage to persons or property asa matter of products liability, negligence or otherwise, or from any use or operation of any standards,recommended practices, methods, products, instructions, or ideas contain in the material herein. Because ofrapid advances in the health care sciences unparticular, independent verification of diagnoses, medicationdosages, and individualized care and treatment should be made. The material contained herein is notintended to be a substitute for the exercise of professional medical or nursing judgment.The content in this publication is provided on an “as is” basis.TO THE FULLEST EXTENT PERMITTED BY LAW, AORN, INC. DISCLAIMS ALL WARRANTIES,EITHER EXPRESS OR IMPLIED, STATUTORY OR OTHERWISE, INCLUDING BUT NOT LIMITEDTO THE IMPLIED WARRANTIES OF MECHANTABILITY, NON-INFRINGEMENT OR THIRDPARTIES RIGHTS, AND FITNESS FOR A PARTICULAR PURPOSE.This publication may be photocopied for noncommercial purposes of scientific use or educationaladvancement. The following credit line must appear on the front page of the photocopied document:Reprinted with permission from The Association of periOperative Registered Nurses, Inc.Copyright 2012All rights reserved by AORN, Inc.2170 South Parker Road, Suite 400Denver, CO 80231-5711(800) 755-2676 www.aorn.orgVideo produced by Ciné-Med, Inc.127 Main Street North, Woodbury, CT 06798Tel (203) 263-0006 - Fax (203) 263-4839www.cine-med.com
Talble of ContentsIntroduction. 1Procuring . 1Prescribing . 2Transcribing . 3Dispensing . 3Administering . . 3Monitoring . . 5Workplace safety . . 5Environmental Safety . 6summary . 6resources . 6POSTTEST . 7ANSWER SHEET . 9
Independent Study forPerioperative Medication Safety PracticesIn 2011, AORN released a new “Recommended practicesfor medication safety.” The recommendations are fullyachievable and are intended to reflect current knowledgethat promotes optimal levels of practice. Perioperativeregistered nurses (RNs) are encouraged to adopt thesepractice guidelines across various practice settings –not only traditional operating rooms and ambulatorysurgery centers, but also physicians’ offices, endoscopycenters, radiology departments, and other sites whereinvasive procedures are performed.The “Recommended practices for medication safety”offers guidelines for perioperative RNs to develop,manage, and evaluate safe medication practices. Theseguidelines build on the RN’s knowledge of the nursingprocess (i.e., assessment, planning, implementation, andevaluation) and add a new dimension known as themedication-use process. The medication-use processhas phases of pharmaceutical care commonly knownas procuring, prescribing, transcribing, dispensing,administering, and monitoring. Perioperative RNscan reduce opportunities for medication errors byunderstanding the medication-use process.The purpose of this independent study is to presentkey points from the “Recommended practices formedication safety” and to advocate for safe medicationuse practices across the perioperative continuum. The“Recommended practices for medication safety”highlights the role of perioperative RNs, not only inadministering medications safely, but also the importantrole they have in each phase of the medication-useprocess.Perioperative RNs join many other health professionalsin establishing a multidisciplinary team approach formedication management with the goal of preventingmedication errors. This often means representationon the hospital pharmacy and therapeutics committeeor in ambulatory surgery centers, the perioperativemedication safety committee. The responsibilities ofthe medication safety committee include creating andenforcing a plan that outlines structures, processes,and professional responsibilities that promote riskreduction strategies across all six phases of themedication-use process. The influence of medicationsafety committees is most evident when assessing thehealth care organization’s (HCO’s) formulary, selectingtechnologies that promote safe medication practices,and investigating medication information resources.PROCURINGSafe medication-use practices begin with theprocurement of medications, chemicals, reagents, andrelated supplies. This is the first point at which theperioperative RN can participate in the medication-useprocess. Perioperative RNs participate in the procuringphase of the medication-use process by identifyingrisk points when selecting, ordering, and storingmedications. The perioperative RN’s participation atthis point in the medication-use process is critical forseveral safety reasons. Perioperative RNs can influencehow these products are obtained and how unexpectedshortages will be handled and communicated. Productsshould be obtained only from manufacturers andsuppliers that have established quality programs.Input from perioperative RNs is considered whendetermining how medications are stored at the facility,including monitoring par levels, how stock is rotatedto ensure products are not stored beyond the expirationdate, and how compliance with environmental concerns(eg, temperature) can be achieved and monitored.Perioperative RNs should identify concerns and seeksolutions for emergency carts that contain rarely usedmedications to be sure the medications are not outdatedor unavailable when needed.A well-recognized threat to safe medication use dealswith product names, either trade or generic. Too often,medications have names that look like or sound likeother medication names. Perioperative RNs shouldfamiliarize themselves with the HCO’s list of productsthat fall into the look-alike or sound-alike categories.Ensuring that products are stored in a manner to reduceopportunities for mistakes occurring with look-alike orsound-alike medications is another important elementof the perioperative medication safety plan.Many of the medications associated with perioperativecare have additional compliance requirements basedon local, state, or federal regulations and laws.Perioperative nurses should oversee compliance withsafe procurement and storage practices to eliminate thepossibility of diversion. Complying with regulations1
includes storing products securely in areas with limitedaccess and completing accurate documentation for whoaccessed medications and appropriate waste.Given that perioperative care can be delivered in multipleareas within a HCO, the perioperative medication safetyplan should strive for standardization throughout theorganization to the greatest extent possible. This meansthat perioperative RNs should participate in creatinguniform unit-based protocols that mirror protocols inother areas. Examples of implementing uniformity canbe achieved by standardizing medication dispensingcabinets, anesthesia carts, emergency carts, and formsused for ordering medications.When automated medication dispensing cabinets areused in a facility, perioperative team members shouldconsult with the cabinet’s manufacturer to adopt theirsafety practices into the perioperative procedures (eg,how to “set up” the various compartments or bins).Perioperative RNs should identify risk factors, suchas medications that are arranged alphabetically or withvarious strengths of a product adjacent to one another.Perioperative team members should advocate forarranging medication products across the compartmentsto avoid placing look-alike or sound-alike productsin close proximity to one another and checking withmanufacturers to access information on “best practices”for storing “high-alert” products. As nurses withdrawproducts from the medication dispensing cabinets, theyshould be suspicious if products in the same drawer orbin look different than they have in the past. Althougherrors that occur when stocking medication dispensingcabinets may be uncommon, they can happen andintroduce opportunities for medication errors. For thisreason, it is important for nurses to review and verifyeach product when each one is removed from thecabinet.In their daily practice, perioperative RNs may be awareof many products that are available in different strengthsand concentrations. Nurses should strive to minimizevariations in packaging size and reduce the numberof the concentrations available facilitates the goalof creating standardized dosing orders on procedurepreference cards or standing medication order forms.Nurses can identify products that need to be obtainedby the facility in the final unit-of-use concentrations toavoid requiring additional manipulation by health careprofessionals. Perioperative RNs can also influence achange in practice by advocating that the organizationobtain single-use vials, an action that is highly preferredover stocking multi-dose vials, which promote the riskof cross contamination as well as unnecessary waste.2Nurses should ensure that chemicals and non-medicationsolutions are stored in separate areas in the facility.Having these products separated from medicationsreduces the possibility of mistaking a chemical solutionfor a medication. Chemicals and other non-medicationsolutions should rarely, if ever, be removed from theoriginal container.PrescribingMedication orders originate with a licensed prescriber.Within perioperative care, there can be multipleprescribers involved, such as primary care physicians,surgeons, anesthesia professionals, and advancedpractice nurses. The prescriber bears the responsibilityof providing clear, unambiguous medication ordersthat are complete and accurate. All prescribers shouldhave access to patient level information as well asaccess to current reference material. Regardless of themanner in which medications are ordered, prescribersshould promote safety by avoiding the use of acronyms,abbreviations, and trailing zeros. Nurses and prescribersshould perform an annual review of their organization’s“Do-not-use” list of abbreviations and acronyms withall team members and include a system to monitor theseactivities within their perioperative continuous qualityimprovement plan.Medication orders can be conveyed through writing(eg, physician order), electronically (eg, computerizedorder entry), or verbally. Within the perioperativesetting, there can be variations with written orders thatrange from long, handwritten orders, to fill-in-the-blankpreprinted order forms. Standing orders frequentlycontain medication orders and preference cards mayeither list the medications to be available during aprocedure or may identify medication orders. Eachmode of order carries both safeguards to prevent errorsand risks for introducing a medication error.Many facilities are now investing in electronic systemsthat include prescribing and documenting features.When armed with clinical decision support, theseelectronic order systems offer many advantages tomanual prescribing. The clinical decision supportcomponent of these systems can rapidly detect allergyinformation, medication-to-medication interactions,and out-of-range orders. Electronic systems canalso reduce the incidence of unsigned verbal orders.Ideally, the perioperative team’s input is essential inthe decision making process involved in obtainingelectronic systems.
TranscribingAdministeringPreference cards are commonly used in perioperativesettings to:Just as in any other part of nursing care, the medicationuse process is closely linked to the nursing process.Therefore, the administering phase of the medicationuse process consists of assessing the patient, planningfor medication use, and implementing (administering)the medication. identify what is anticipated for the procedure and/orcharge for medications that are used during thesurgical procedure.When medications are included on the preference card,the perioperative RN should comply with policiesregarding transcribing the medication order to theperioperative record or the medication administrationrecord to ensure accurate documentation. Perioperativeteam members should review preference cards atleast annually. Any changes to a preference card mustbe clearly communicated to the surgeon to validateaccuracy. Policies and procedures direct the process forupdating electronic preference cards and establishingthe medications on preference cards as standingorders. Medications listed on preference cards are notconsidered to be standing orders unless they have beenreviewed and signed by the prescriber.Medication orders may not be necessary if themedication is being given by the person prescribing themedication. Verbal orders, while generally discouraged,may occur in some perioperative settings when the RNwill be the one to administer the medication. When theperioperative RN receives a verbal order, he or she mustconfirm with the order with the prescriber by verballyreading back the order digit-by-digit, or by writing theorder on a white board so the prescriber can visuallyconfirm the order. Verbal orders, when received, mustbe entered into the perioperative record as soon aspossible.DispensingAORN’s “Recommended practices for medicationsafety” strongly supports the involvement of pharmacistsin the perioperative medication safety plan. Pharmacistsnot only serve in the role of dispensing medicationsfor patient use, but also serve the HCO as expertsthroughout the medication-use process and relatedactivities. Pharmacist oversight of standing orders,preprinted order forms, and preference cards should beevident. Pharmacists should also participate in a reviewof all medication orders before actual medicationadministration occurs. Facilities are encouraged to havedecentralized (eg, satellite) services in the perioperativesetting. Decentralized pharmacy services can assist withsterile compounding, providing medication referencematerials, and ensuring compliance with documentationstandards associated with controlled substances.Assessment. Perioperative RNs are responsible formany interventions that serve to ensure safe medicationpractices prior to medication administration. One of theearliest interventions occurs during the preoperativeassessment when the patient’s overall condition isassessed and the patient’s weight is documented.Many medications use the metric system; therefore,perioperative RNs should document the patient’sweight in both pounds and kilograms. Standardizedconversions charts can assist with the process if theorganization does not have weight scales that displaythe weight in both pound and kilograms.Perioperative RNs also have a role in medicationreconciliation. The nurse should interview the patientand family members to identify the reason the patientis taking each medication. Knowing the therapeuticindication of the medication before the plannedprocedure will identify underlying patient conditionsthat may influence positioning or other interventionsduring the planned procedure. To facilitate medicationreconciliation, the patient should be reminded tobring all prescribed medications, over-the-counterproducts, and herbal supplements to the preoperativeappointment. During this appointment, the RN shouldconfirm the name of each product, the dosing schedule,the route of the medication administered (eg, oral,dermal patch), and review known allergies and otherintolerances to medications. The RN should documentthe reconciliation process in a standard format that iseasily reviewable by all members of the health careteam. On the day of the scheduled procedure, the RNshould reconfirm the medication reconciliation list andaffirm that the proper preoperative medications (if any)were taken as directed.Planning. To develop the patient’s nursing medicationplan, the nurse synthesizes the individualized planof care based on the patient assessment, medicationreconciliation, and the anticipated medications that willbe used during the procedure. The nurse’s responsibilitywithin this plan includes contacting prescribers when avariance is noted or additional information is neededand collaborating with pharmacists or others to documentdose calculations of routine and high-alert medications3
and to identify toxic dose ranges. The nursing medicationplan should also address timely administration ofpreprocedural antibiotics. For example, if the patienthas an order for vancomycin, the plan would direct howearly the patient needs to arrive at the facility to allowsufficient infusion time and avoid complications.Implementing. To implement the nursing medicationcare plan, the RN follows safe medication practicesin obtaining, verifying, preparing, and administeringmedications, regardless of the perioperative setting.Key points for implementing safe practices include: obtaining medications for one patient at a time,avoiding distractions and interruptions,preparing the medication as close as possible to thetime of administration, andusing safe injection practices.A primary safe medication practice involves obtainingonly medications for one patient at a time, regardlessof where the medication is stored or from where themedication must be retrieved. It is essential not tocombine medications for multiple patients, or to obtainmedications for procedures scheduled later in the day.These steps are important in reducing wrong-patientmedication errors. When obtaining medications, thenurse confirms the original order against the productin hand and considers the individualized nursingmedication plan for patient conditions and allergies.When the RN begins the process of medicationpreparation and administration, he or she must heedthe rule “task to completion”. This rule infers thatdrug retrieval, preparation, and administration areall performed in a manner that is free of distractions.Interruptions are a large contributing factor tomedication errors. W
Perioperative Medication Safety Practices In 2011, AORN released a new “Recommended practices for medication safety.” The recommendations are fully achievable and are intended to reflect current knowledge that promotes optimal levels of practice. Perioperative registered nurses (RNs) are encouraged to adopt these
B.Known causes of medication errors include: confusing labeling and nomenclature, human and environmental factors and medication shortages C.Medication safety measures include barcoding, smart pumps, medication reconciliation and pharmacists D.Medication errors are the most common sentinel event reported. E.None of the above LEARNINGOBJECTIVES
A healthy perioperative practice environment can be defined as a practice setting that is safe, healing, humane, and respectful of the rights, responsibilities, needs, and contributions of all members of the perioperative team. 1 Members of a highly functioning perioperative team
hyperglycemia, and the management of diabetes in the perioperative period including preoperative evaluation, day of surgery management, and postoperative care. Pathophysiology of perioperative hyperglycemia There are many factors that contribute to hyperglycemia in the perioperative setting. Surgical stress increases secretion of counter regulatory
novice perioperative nurse according to that survey was at least 30,000 to 50,000. The same survey estimated the costs of orientation for an experienced perioperative nurse at 10,000 to 15,000. Perioperative nurse executives and educators need to drill down to a very fine level to determine the true costs of orientation for new employees.File Size: 1MB
Jun 25, 2020 · CD 5A: “What the Whisky Drummer Heard” - 04/17/1954 Dillon isn’t dead, but people think he is! CD 5B: “Murder Warrant” - 04/24/1954 A townsman shot in an ambush has a price on his head. CD 6A: “Cara” - 05/01/1954 Dillon’s old flame comes to town, but is she on the wrong side of the law? CD 6B: “The Constable” - 05/08/1954
US support for the French - paying up to 80 percent by 1954 Battle of Dien Bien Phu - April-May 1954 2.) Eisenhower's "United Action" policy - the "domino theory" 3.) US reluctance to intervene 4.) French Defeat - May 1954 YouTube - John Foster Dulles on the Fall of Dien Bien Phu (1954)
a. Read medication administration plan b. Read label 4. Observe student prepare and take medication as per medication plan 5. Document as required or stated in plan a. By unlicensed school staff member b. By student RECORDING MEDICATION ADMINISTRATION 1. Use Medication Administration Daily Log (paper or computer) 2. Record in ink only if using .
Operation Guide for the Mercedes-Benz GLA/CLA This is a basic operation guide for those who are driving the Mercedes-Benz GLA/CLA vehicle for the first time. Please read this guide before you leave the rental office if you are not familiar with operation. For more information about the vehicle, please read the instruction manual. Basic Operations to Note Before Driving the Vehicle Starting .
