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is being prepared and verbally confirm that the proper medica- tion is being delivered. Culture improvement Errors in medication man- agement and delivery aren't limited to just accidentally giving the wrong drug. They're caused by a host of potential errors, ranging from impurity to improper rate of delivery, to failure to consider the downstream effects hours or days later. All medications and biologics have long-term effects. Under- or over-transfusion and over- or underuse of vasopressors, muscle relaxants and other medications are mistakes not often categorized as medication errors or addressed by accreditation organizations, yet they are quite important. You might be surprised by how staffers vary in their labeling and medication practices, without guidance. It's essential that you confirm that uniform standard practices are being observed. Ingrain medication safety into the 4 Safety S 1 5 0 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 6 Failure to read the label on a syringe or vial when administer- ing a medication is a clear hazard. Of course, that's only one type of potential medication error. Consistently monitor how and why mistakes occur and monitor your facility's own prac- tices to improve vigilance at the front line. Here are a few key points to consider: Common errors • Drug is indicated, but not given • Drug is not indicated, but selected • Drug is contraindicated • Drug interactions are not considered • Wrong dose/infusion rate • Wrong route Why errors occur • Labeling mistakes and syringe swaps • Improper techniques during drug preparation (reuse of syringes, contamination, wrong concentration/wrong drug) • Needed drug or the needed quantity isn't available • Lack of prompting for "routine" drugs • Unaware of contraindications • Failure to properly program delivery rates • Lack of familiarity with delivery systems • Failing to standardize the OR environment — especially anesthesia work areas — leads to chaos and distraction — Jerry A. Cohen, MD PRACTICE PITFALLS Why Do Medication Errors Occur?