How are meds handled in OR?
Prepared and delivered to sterile field by circulator
Scrub nurse prepares and labels
Meds are administered by surgeon
Circulator documents
5 steps of medication process?
Med procurement Prescribing Transcribing/documenting Dispensing/preparation Administration Pt monitoring
Pre op assessment/interview related to meds?
Med Rec
- what is patient currently taking
- prescriptions, OTC, herbal, street drugs
When were meds last taken?
Were any meds d/c’d as per pre op instructions
- notify surgeon and anesthesia if meds were taken or not taken
Allergies
Pt weight, age, med hx
Near miss of med admin?
Detected before administration
Can occur at any point of med admin process
Errors influenced by many factors
What do you need to know about meds when administering?
Usual route Routes of admin Limits on rate & max dose Duration of action Changes expected Normal and abnormal reactions Appropriate actions to take if unwanted reaction occurs
What are you monitoring for after administering meds?
Side effects
- CNS disturbances
- hypersensitivity
Adverse reactions
- N/V
- diaphoresis
- palpitations
Allergic reactions
- laryngeal edema
- high temp
- tachy
Documentation of meds?
Timely manner Legible Easily accessible No abbreviations Consistent format
What is a consistent format for documentation of meds?
Name of med Concentration Date and time administered Time completed Team member administering Pt response Admin rate Route Amount of multiple injections of same med
Who can give med orders?
Anesthesiologist
Surgeons
Advance practice RNs
Safety for procurement of meds?
Use single dose units
Use prefilled syringes
Limit # of concentrstions available
Purchasing in a size close to anticipated dose
Scheduling of medications?
1 - no medical use - heroin
2 - high potential for abuse/dependence - methadone
3 - low/moderate potential for dependence - codeine
4 - low potential for abuse - ativan
5 - lowest potential for abuse
Storage of medications?
All meds and rekated supplies must be stored securely in areas with likited access
All class 2, 3, 4 & 5 must he in locked location
Orgaization of med storage?
Standardized manner
Seperate by generic name and packaging Seperate high alert meds Seoerate bins/dividers for all meds Labelling with tall man lettering Position so label visible AVOID alphabetical storage
Writting verbal orders?
No trailing zeros
Use leading zeros
No abbreviations
Problem with verbal orders?
High chance of errors
- confirm by reading order back to surgeon
- record in pt chart
- have surgeon review, validate and sign order
What is required on preference card?
Helps streamline process of ibtaining supplies
Allows to focus on pt care
Needs: Procedure name Pt position/devices Instruments Meds Irrigation solution Sutures Dressings
Can you retrieve meds for multiple pts at once?
No
High chance of error
1 pt at a time
Verifying med to original order
What is compounding meds?
Combining 2 or more meds together
Never compound more than 3
Preferred to be done in pharmacy
- sterile
When done in OR compound for immediate use
Administer within 1hr of compounding, continually observe for contamination
Steps to compounding?
Hand hygiene
Disinfect surfaces
Aseptic technique
Use dispensing equipment or a sterile syringe to remove
Verify correct medication, amount and concentration
Visually inspect
Apply label if not being used immediately
Labelling compound solution off sterile field?
Pt identification Names and amounts of all ingredients Name of who prepared Date of prep The beyond use date and time Different colour labels with multiple concentrations Full medication name Tall man lettering
Labelling compound meds on sterile field?
Med name, strength, dilution and dilutent
Date and time accepted onto sterile field
Full med name
Tall man lettering
Who performs double checks on high alert meds?
2 licensed individuals
Ex. Heparin, insulin
Common causes of med errors?
Dose miscalculation Name mix ups Omission errors Wrong time Syringe swap Neglecting MIFU
Rights to med admin?
Patient Med Dose Route Time Strength/concentration Rate Infusion pump settings
What orders must be documented?
Verbal orders
Standing orders
Orders on preference cards
Order sets
Documented, dated, timed wnd authenticated
Routes of med admin transfered onto sterile field?
Injection
Topical
Irrigation
Flush
What reverses effects of heparin?
Protamine
What does papaverine hydrochloride do?
Muscle relaxant
Treat spasms
Medications common in OR?
Local anesthetic Antibiotics Anticoags Cardiac agents Epinephrine
Chemo therapy agents?
Hazardous
Follow MIFU when mixing
Limit exposure
Wear PPE
- change gloves q30min
What does contrast media do?
Enhances the visibility of blood vessels, fluid and other structures
2 fluid related complications?
Extravasation - absorbed into surrounding space
Intravasation - absorbed into bloodstream
Tools to increase accuracy of fluid measurement?
Drapes designed for fluid collection
Closed suction containers
Fluid pumps
Steps of fluid management?
Consultation with surgeon Monitor I&O during procedure Report fluid deficits Monitor pt for retention - edema, labs, temp, VS Document
Non electrolyte fluids?
Low viscosity
Often used with monipolar instruments
Hypotonic fluids
Cause cause TUR syndrome
Ex mannitol, glycine, sorbitol
Normal saline?
Often used in bipolar
Isotonic
Safer is absorbed
High viscosity fluids?
Do not blend with blood
Provides good visibility
Ex. Dextran
- can draw 6x its own volume into blood stream
Methylene blue dye?
Common dye/staining agent
Main purpose of using is to check for leaks
Examples of hazardous chemical agents?
Anesthetic gases Toxic fumes Cytotoxic agents Cleaning agents Tissue preservatives Methyl methacrylate
Handling hazardous agents?
As per MIFU Store as per requirements PPE Dispose PPE in hazardous disposal containers Hand hygiene Leak proof containers Follow safety data sheets Have spill kits available Immediate attention if exposed Never spray cleaners when cleaning Follow MFIU when cleaning
Eye wash station?
Easily accessible
- 10sec away from chemical use/storage
Deliver warm water between 60-100F at rate of 1.5L/min
Flush stations weekly
What is drug diversion?
When prescription drugs are used/obtained illegally
What is mannitol used for?
Treat intracranial pressure
Diuretic
Common anaphylactic symptoms?
Headache Anxiety Stridor Abd pain Tachy Hypotension Itchiness Swelling
