STANDARDIZATION:
High alert drugs in standard concentrations. Ideally prepared by the pharmacy in ready-to-use form.
Ready to use syringes and infusions should have standardized fully compliant machine-readable labels.
Additional ideas: interdisciplinary and uniform curriculum for medication safety to all training programs and facilities, no concentrated version of any potentially lethal agent, required read-back in an environment for extremely high alert drugs such as heparin, standard placement of drugs within anesthesia workstations, convenient method to save all used syringes and drug containers until case conclusion, standard infusion library/protocol throughout the institution, standard route-specific connectors for tubing.
TECHNOLOGY:
Every anesthetizing location should have a mechanism to identify medications before drawing up or administering along with a mechanism to provide feedback, decision support, and documentation.
Additional ideas: technology training and device education for all users, improved/standardized user interfaces on infusion pumps, mandatory safety checklists incorporated into all operating room systems.
CULTURE:
Establish a “just culture” for reporting errors (and near misses) with a discussion of lessons learned.
Establish a culture of education, understanding, and accountability via the required curriculum and continuing education.
Establish a culture of cooperation and recognition of the benefits within and between institutions, professional organizations, and accreditation agencies.
PHARMACY/PREFILLED/PREMIXED:
Routine provider-prepared medications should be discontinued whenever possible.
Clinical pharmacists should be a part of the perioperative/operating room team.
Standardized pre-prepared medication kits by case type should be used whenever possible.
Additional ideas: interdisciplinary and uniform curriculum for medication administration, enhanced training of O.R. pharmacist, deployment of ubiquitous automated dispensing machines in the O.R. suite.
