Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/310593
1 0 6 O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | M AY 2 0 1 4 correct storage drawer or bin to open. But isn't it worth a couple sec- onds for effective fail-safes to work? Besides, most anesthesia providers who use smart storage solutions soon realize the process doesn't take as long as they anticipated. • Communication. Medication orders are rarely written down in the OR — it's an area where verbal orders are common. Unfortunately, so are communication breakdowns. A hospital once had a near-miss event involving an anticoagulant used for heparin-induced thrombocytope- nia (HIT). After a patient was diagnosed with HIT in post-op, a hema- tologist gave a verbal order to the surgeon to start argatroban 2mcg/kg per minute. The surgeon heard it as an order for Orgaran, the brand name of a low-molecular weight heparin — not the drug you want to give to someone who's having a negative reaction to heparin. The surgeon called the OR pharmacists to give the verbal order for Orgaran. The pharmacist questioned the dose, but not the drug, and called the hematologist to verify the order, who confirmed that the drug should be administered at mcg/kg per minute. They discussed the deliv- ery rate, but didn't figure out they were talking about 2 different drugs. To avoid communication-based mistakes in pre-op and the PACU, write down verbal medication orders immediately in patients' charts or enter them into electronic health records, and read what you docu- mented back to the prescriber. Never write orders on scrap paper for rewriting them into the patient's record. Best practice is to record and read back orders immediately. When responding to verbal orders in the sterile field, where immediate documentation might be impossible, at least repeat the order and ask for verbal confirmation back. Proactive prevention Medication handling can easily drift from acceptable practices to at- risk behaviors. Several medication safety problems you're not aware P A T I E N T S A F E T Y OSE_1405_part2_Layout 1 5/8/14 2:24 PM Page 106