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AORN issues recommendations on medication safety

Sunday January 15, 2012
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After months of research and evaluation, the Association of periOperative Registered Nurses has released a new recommendation about medication safety practices.

Available in the association's newly released 2012 edition of "Perioperative Standards and Recommended Practices," the recommendations support positive outcomes and quality patient care before, during and after surgery.

In a news release, AORN noted medication safety has become increasingly important as state and federal inspections focus on safe injection practices and accreditation organizations focus on national goals aimed at reducing medication errors. Although perioperative nurses may watch closely for errors while medications are administered, the 2005 MEDMARX Data Report revealed errors at the point of care often stem from mistakes earlier in the medication use process.

The newly published recommendations outline best practices for all six phases of medication use: procuring, prescribing, transcribing, dispensing, administering and monitoring.

As with all published recommendations, the medication safety review process included a 30-day public period during which comments came in from perioperative nurses nationwide and from representatives of the American Nurses Association, Food and Drug Administration, Institute for Safe Medication Practices and other agencies.

The recommendations encompass a multidisciplinary approach and can be used by all members of the perioperative team in all perioperative practice settings, according to AORN.

"This medication safety RP expands the description of medication safety by looking at broader risk points in the 'life' of a medication from the point of storage through to the point of disposal of the medication after it has been given," Bonnie Denholm, RN, BSN, MS, CNOR, a perioperative nursing specialist with AORN and lead author of the RP, said in a news release.

A few of the recommendations could be controversial to some, admitted Ramona Conner, RN, MSN, CNOR, manager of AORN's standards and recommended practices. The recommendation to puncture intravenous solution containers as close as possible to the time of use may affect efficiency. And some OR personnel may disagree with the recommendation against the use of multidose vials, which are a cost-saving-measure but which evidence indicates pose a risk of cross-contamination.

"We have received quite a few inquiries about outbreaks that have been reported relating to the use of multidose vials and syringes," Conner said. "It was important that this RP lay it out, be very specific and provide comprehensive guidance."

Other key recommendations address taking a multidisciplinary team approach that includes pharmacist involvement in the perioperative medication management process; developing systems to evaluate compliance with safe practices at each step in the medication use process; assessing patients before and after administering medication; and using aseptic technique when transferring medications to the sterile field and during incremental injections.

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