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Medication Practices and Guidelines to Avoid Medication Errors

The circulator assumes responsibility for all medications provided to the scrub person and the surgeon. Most medications should be kept in a cool, dry place; some medications require refrigeration.All medications on the sterile field must be in a sterile container, labeled with the name, the strength, and the dosage of the medication.The scrub person identifies all medications on the sterile field by writing with a sterile skinmarking pen on paper labels that have been sterilized.All medications in solution must be transferred to the sterile field in an aseptic manner.The circulator may use a syringe to draw up a medication in solution before transferring it to a sterile cup. Medications in solution can also be transferred to the sterile field using a sterile vial spike, a sterile filter straw, or a sterile catheter; they may not be poured from bottles with stoppers.

A current, reliable medication reference book should always be available in the OR department for use by personnel. Medication errors must be reported and corrected immediately; an Incident Report form should be available for reporting medication errors. Periodic reviews of
medication errors should be made to analyze how and why a particular medication error was made and how it can be prevented in the future. “Constraints,” as recommended by AORN, are approaches that should be used to avoid errors when administering medications; examples include minimizing the number of medication calculations required and stocking dose-related bottles of medication whenever possible. In addition, the competency of perioperative personnel who administer medications should be evaluated on a regular basis.

To ascertain if a patient is allergic to a requested medication, the patient is asked directly (if possible), and the front of the chart and the preoperative assessment checklist are consulted. Adequate time must be taken to verify that the correct medication is being given, by the correct route, in the correct dosage, and, to the correct patient, as ordered by the surgeon. The protocol for the administration of medication should be checked and rechecked.

When a medication is dispensed to the scrub person, the circulator should state the name of the medication, the strength, and its dosage aloud, while showing the labeled bottle to the scrub person for verification. When a medication must be prepared (in solution), calculations should be checked and rechecked by the person dispensing the medication and the calculations should be verified by another licensed professional. Any unused portions of a used (i.e., opened) medication should be discarded at the completion of the procedure. Any unlabeled medications found in the OR are always discarded.When the scrub person and the circulator are relieved, all labeled medications being used are shown to the relief person(s).The relief person(s) is/are required to take note of specific medications and their locations on the sterile field. Medication containers or vials and the items used for medication preparation and delivery during a surgical procedure must remain in the room until the completion of the procedure. During a procedure, the trash is never to be removed from the room before the conclusion of the procedure. AORN guidance statement suggests using the five “rights” when administering medication: 1) the right patient, 2) the right medication, 3) the right dose, 4) the right time, and 5) the right route.
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