Medications and Solns

AORN's definition of moderate sedation is:

"A minimally depressed level of consciousness that allows a surgical patient to retain the ability to independently and continuously maintain a patent airway and respond appropriately to verbal commands and physical stimulation."

List/describe at least one medication error that could happen in Transcribing/documenting phase and how it could be avoided.

*during the administering phase, a emdication could go to the wrong person if it was transcribed/recorded wrongly *Ommission error: medication is not transcribed therefore the patient misses to take his medicine

List/describe at least one medication error that could happen in Prescribing phase and how it could be avoided.

*each provider has their own different way of prescribing meds which can be very dangeroous whether it be written or verbal orders To rectify this situation: *Providers should knoe their pt well including allergies, past medical histrory *Providers should use Beers criteria or other tools to identify meds that are inappropiate in certain age groups such as the elderly *Medication orders in preprinted forms, standing orders, and preference cards should be reviewed annually *Limit verbal orders *Use CPOE systems (computerized provider order entry) when available because they redice lots of errors

List/describe at least one medication error that could happen in Dispensing phase and how it could be avoided.

*failing to detect an error during this phase may lead the pt to be administered wrong med To rectify: *use COPE system which help avoid many errors *use automated dispensing storage systems

The 6 Phases of the Medication Use Process:

1. Procuring 2. Prescribing 3. Transcribing/Documenting 4. Dispensing 5. Administering 6. Monitoring

The 7 Rights of Medication Administration:

1. Right Patient 2. Right Medication 3. Right Dose 4. Right Time 5. Right Route 6. Right Indication 7. Right Documentation

The Perioperative RNs role in both preparing and administering medications include:

1. Verifying: The perioperative nurse is frequently the primary person responsible for verifying the correct medication or solution, as well as the proper route and dose of the medication or solution. 2. Preparing: Verbal orders for medication administration should be minimized. Label all medications, medication containers, and other solutions. The perioperative nurse should write down and read back any verbal orders, per facility policy. Avoid using abbreviations that could cause medication errors. The Joint Commission (JC) has formulated a list of "Do Not Use" abbreviations that have been known to cause errors. Your facility may also have its own list. Please check with your policy. 3. Obtaining Patient History: The perioperative nurse must now obtain the patient's relevant history. Current medications and dosages Medication allergies and idiosyncratic responses Potential interaction with other medications Herbal or dietary supplements Patient's weight, age, and existing disease or condition

How should you label medications?

All medications and solutions on and off the sterile field must be labeled with: Medication name Concentration and amount of the medication or solution if not apparent from the container Initials of the RN preparing the medication Expiration date when not used within 24 hrs Expiration time if less than 24 hrs (applies to only a few drugs) Date prepared

What is hypervolemia?

An excessive volume of fluid in the vascular space. An abnormally increased volume of blood.

Adverse reactions to hemostatic agents:

Avoid use of microfibrillar collagen with autologous blood salvage units.

List/describe at least one medication error that could happen in Administering phase and how it could be avoided.

Errors: Wrong dosage due to its dependence on calculating the patient's weight. Weight should be recorded both in kg and lbs To rectify: *only remove meds for 1 pt only *verify that you have pulled put the correct meds by looking at the meidcation order *prepare meds as close as possible to the time of administering it. *use the seven rights of administering meds

Symptoms of systemic toxicity include, but are not limited to:

Metallic taste Tinnitus Lightheadedness Visual disturbances Numbness of tongue and lips Confusion Tremors Shivering Generalized seizures Tachycardia/hypertension (initially) Bradycardia/hypotension (with increased toxicity) Ventricular arrhythmias; cardiac arrest Respiratory arrest

Should medications that are removed from their original containers be considered safe?

NO Medications that are removed from the original package and not labeled cannot be verified before administration, increasing the risk for administering the wrong medication. Medications that are removed from the original package and found in a secondary container without a label should be discarded!

Examples of moderate sedation agents are:

Opioids (morphine sulfate, meperidine hydrochloride, fentanyl) Benzodiazepines (diazepam, midazolam) Propofol

Prescribing and Dispensing Phase:

Prescribing personnel should provide clear, unambiguous, and accurate medication orders. Pharmacists should be actively involved in dispensing phase of the medication use process across all perioperative settings. Some examples include: When available, prescribers should use CPOE systems (Computerized-provider order entry). Those systems with rule-based decision support aids have reduced the opportunity for errors. Advantages of a CPOE include: Allowing electronic recording of medication administration Decreasing the risk for misinterpretation of medication orders due to illegible handwriting or misunderstood verbal orders

Drug Diversion:

To prevent incidences of drug diversion by OR personnel, only authorized personnel should have access to medications, including controlled substances, and medication supplies. Policies and procedures should be developed by your facility.

The following guidelines should be noted while transferring solutions:

Use of sterile technique: the medication or solution must be transferred to the sterile field using sterile technique. Do not remove stoppers from the vials for the purpose of pouring medications. Use commercially available sterile transfer devices whenever possible.

List/describe at least one medication error that could happen in monitoring phase and how it could be avoided.

errors that could occur *not evaluating the effects of the medications on patient on time *not documenting adverse effects immediately as they occur

List/describe at least one medication error that could happen in Procuring phase and how it could be avoided.

inaccurately placing meds in the storage in a wrong manner How to rectify it: compare the list of look alike and sound alike to that of medication inventory

What is hyponatremia?

it is reduced blood sodium concentration. An abnormally low concentration of sodium ions in circulating blood; serum sodium less than 135 mEq/L.

Factors affecting the medication use process in the perioperative environment include, but are not limited to:

the aseptic transfer of medications onto the sterile field, the presence of an intermediary (eg, scrub person) who is in sterile attire to receive and transfer dispensed medications to the licensed independent practitioner who is in sterile attire (eg, surgeon), time-sensitive conditions, and sensory distractions intrinsic to the environment.

Risk for errors at the Procurement phase of the medication use process can be reduced by making proactive decisions about:

unit-of-use versus multi-dose containers - NO multi-use containers! shelf life general supply chain which includes medication availability, delivery, and protection during transit