Revised April 14 2017 Guidelines For Safe Medication-Books Pdf

Revised April 14 2017 Guidelines for Safe Medication
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The numbers and information is provided to place strong emphasis upon the importance. of CSTs following the AST guidelines for safe medication practices as well as remaining current. with the information that is published by other organizations and agencies CSTs must continue. their duty of care to the surgical patient by providing safe efficient care that contributes to. preventing medication errors which also contributes towards the attempts to control the costs of. healthcare, Evidence based Research and Key Terms, The research of articles letters nonrandomized trials and randomized prospective studies is. conducted using the Cochrane Database of Systematic Reviews and MEDLINE the U S. National Library of Medicine database of indexed citations and abstracts to medical and. healthcare journal articles, The key terms used for the research of the Guidelines include administration dispense. label principles of asepsis six rights for medications sterile technique Key terms used in the. Guidelines are italicized and included in the glossary. Guideline I, CSTs must follow the six rights of medications including handling and dispensing. 1 The CST and surgical team must confirm the right patient. A All surgical patients shall be accurately identified prior to being transported to the. OR and during completion of the time out 5, 1 Identification of the patient includes confirming the name of the. patient history of drug allergies surgical procedure and operating. 2 The CST and surgical team must confirm the right drug s. A All drug s to be used during a surgical procedure must be accurately identified 4. 1 The surgeon s preference card must be used to obtain the correct. drug s that are required for the surgical procedure Abbreviations. symbols and dose designations listed in the table of error prone. abbreviations symbols and dose designations should not be used. when creating or updating surgeons preference cards 7. 2 When the circulating person delivers a drug s to the sterile back. table the CST and circulating person must confirm the name and. strength of the drug and expiration date The Joint Commission. states the following in the National Patient Safety Goals 03 04 01. Verify all medications or solution labels both verbally and visually. Verification is done by two individuals qualified to participate in. the procedure whenever the person preparing the medication or. solution is not the person who will be administering it 6. 3 The CST is required to immediately and accurately label the. container e g syringes including Asepto syringe bulb syringe. graduated pitcher medicine cup 6 The Joint Commission states the. following in the National Patient Safety Goals 03 04 01 Label all. medications medication containers and other solutions on and off. the sterile field in perioperative and other procedural settings. Medication containers include syringes medicine cups and basins. In perioperative and other procedural settings both on and off the. sterile field label medications and solutions that are not. immediately administered This applies even if there is only one. medication being used 6 The Joint Commission also states that. any medication or solution found unlabeled must be immediately. discarded 6, The medication label must not cover the increments on a.
syringe The CST should avoid using abbreviations symbols and. dose designations that are listed in the table of error prone. abbreviations symbols and dose designations 4 7 The Joint. Commission recommends the following to be included on the. label medication or solution name strength amount of medication. or solution if not apparent from the container such as a syringe. with increments diluent name and volume if not apparent from. the container 6, 4 All empty medication vials bottles or other containers must be. kept in the OR until the end of the procedure as evidence the. proper medication has been delivered to the sterile field and. administered to the patient 8 The Joint Commission states the. following in the National Patient Safety Goals 03 04 01 Remove. all labeled containers on the sterile field and discard their contents. at the conclusion of the procedure This does not apply to multiuse. vials that are handled according to infection control practices 6. 3 The CST and surgical team must confirm the right dosage of the medication. A All drug s dosages to be used during a surgical procedure must be accurately. identified, 1 The surgeon s preference card must be verified for medication. dosages Abbreviations symbols and dose designations listed in. the table of error prone abbreviations symbols and dose. designations should not be used when creating or updating. surgeons preference cards 7, 2 When the circulating person delivers a drug s to the sterile back. table the CST and circulating person must confirm the dosage of. the drug when also confirming the name of the drug and expiration. 3 The CST must take explicit care when there is more than one. dosage of the same medication on the sterile field e g two. different dosages of epinephrine for a middle ear procedure. 4 The CST provides the final safety check for the intended dosage by. always stating the name and strength of the drug when. handing passing it to the surgeon 8, 4 The CST and surgical team must confirm the right route of the drug administration. A All drug s administration routes to be used during a surgical procedure must be. accurately identified, 1 The surgeon s preference card must be verified for medication.
administration routes, 2 When the circulating person delivers a drug s to the sterile field. the CST and circulating person must confirm the administration. route when also confirming the medication name dosage and. expiration date, 3 The CST must take explicit care when there is more than one. dosage of the same medication on the sterile field Differing. dosages of the same medication often have varying routes of. administration 8, 5 The CST and surgical team must confirm the right time of the drug administration. A All drug s time of administration during a surgical procedure must be accurately. 1 The surgeon s preference card shall be verified for a medication s. time of administration, 2 The purpose of the drug when stated on the surgeon s preference. card often indicates the timing of administration, a A medication listed as a local anesthetic will be.
administered before the incision is made or during the. procedure as needed, b A medication listed for postoperative pain control may be. administered at the beginning of the procedure or after. wound closure, c A medication may be requested by surgeon s verbal order. during the procedure, 3 The surgeon is responsible for the administration of all. medications at the surgical site 8, 6 The CST and surgical team must confirm the correct documentation of the medication. A It is crucial that medications given from the sterile field are accurately recorded in. the intraoperative record, 1 The circulating person will document all medications delivered to.
the sterile field The circulator should avoid using abbreviations. that are listed in the table of error prone abbreviations symbols. and dose designations 7, 2 The CST will verbally provide a final total of the amount of each. medication and solution administered at the sterile field for the. circulating person to record in the intraoperative record. 3 During a break or shift change the initial CST relief CST initial. circulating person and relief circulating person will verbally and. visually identify all medications and solutions including the. amounts used 6 8 9, a The following is stated by The Joint Commission All. medications and solutions both on and off the sterile field. and their labels are reviewed by entering an exiting staff. responsible for the management of medications 6, Guideline II. CSTs and surgical team must follow sterile technique when medications are dispensed onto. the sterile field, 1 The method s of transferring medications to the sterile field will be based on the type. and route of medication administration Controlled substances may require a different. type of handling per individual facility and state policies. A Medications from a vial may be transferred to the sterile field by one of three. 1 The circulating person cleans the stopper on the top of the vial and. using a sterile transfer device such as a sterile vial decanter pours. the medication into the proper receptacle on the sterile field. 2 The circulating person cleans the stopper on the top of the vial. draws the medication into a syringe with the use of a sterile. hypodermic needle and ejects the medication into the proper. receptacle on the sterile field, 3 The circulating person cleans the stopper on the top of the vial and.
holding the vial upside down the CST withdraws the medication. into the syringe with the use of a sterile hypodermic needle. B Medications from an ampule may be transferred to the sterile field by one of two. 1 The circulating person removes the top of the ampule draws the. medication into a syringe with the use of a sterile filter needle and. ejects the medication into the proper receptacle on the sterile field. 2 The circulating person removes the top of the ampule and while. holding the ampule the CST withdraws the medication into a. syringe with the use of a sterile filter needle, C Medications from a tube are squeezed onto the sterile field by the circulating. person using sterile technique It is recommended the CST has the circulator. squeeze the medication onto an uncounted non radiopaque detectible sponge. Medications from a used tube should not be used from case to case and disposed. of at the end of the procedure 8, Guideline III, CSTs are qualified to handle medications in the OR under the direct supervision and. orders of the surgeon, 1 The educational standards established by the Core Curriculum in Surgical Technology. provide CSTs with the knowledge and skills to properly handle medications within the. sterile field These standards include, A Applying medication terminology. B Understanding anesthesia complications and interventions. C Understanding methods agents and techniques of anesthesia. D Correlating anesthesia monitoring devices with patient homeostasis. E Preparing and managing medications and solutions on the sterile field. F Calculating medication conversions and dosages including knowledge of. percentages proportions and ratios, G Analyzing the principles of anesthesia administration and understand the.
necessity of anesthesia preparation of the surgical patient. Guideline IV, Surgery departments should develop policies and procedures P P that mandate who. should be involved in administering and dispensing medications in the perioperative setting. that promotes teamwork and safety, 1 P Ps should define who or which job classification may participate in administering or. dispensing medications, 2 The P Ps must take into consideration local state and federal laws regarding medication. administration and dispensing, A Based upon the research of 37 states pharmacology laws no laws or regulations. were discovered that directly address the role and duties of the CST However the. research was focused solely on the CST and did not include the laws and. regulations that apply to licensed healthcare personnel 10. 3 The surgery department should establish an environment that promotes reporting. learning and interdisciplinary respect and cooperation among the surgery personnel in. the perioperative setting that promotes teamwork and safety 11. Guideline V, The surgery department should review the P Ps regarding safe medication practices on an.
annual basis, 1 The surgery department should include members of the surgical team and administration. when reviewing the P Ps including CSTs surgeons RNs risk management and. infection control officer, A Current literature and reports issued by healthcare care agencies that address new. trends practices and products related to safe medication handling should be. B The surgery department should document when the P Ps were reviewed revision. completed if necessary and who participated in the review process. 2 CSTs should be familiar with the P Ps for safe medication practices The orientation of. new employees should include reviewing the P Ps, Guideline VI. CST s should complete continuing education to remain current in their knowledge of safe. medication practices 12, 1 The continuing education should be based upon the concepts of adult learning referred to. as andragogy Adults learn best when the information is relevant to their work. experience the information is practical rather than academic and the learner is actively. involved in the learning process 13, 2 It is recommended surgery departments use various methods of instruction to facilitate.
the learning process of CSTs, A If the education is primarily lecture methods to engage learners include. presentation of case studies for discussion and audience discussion providing. suggestions for reinforcing safe medication practices. B Other proven educational methods include interactive training videos and. computerized training modules and teleconferences, C The continuing education should be delivered over short periods of time such as. in modules and not in a one time lengthy educational session. Guidelines for Safe Medication Practices in the Perioperative Area Introduction The following Guidelines for Best Practices were researched and authored by the AST Education and Professional Standards Committee and are AST approved AST developed the following Guidelines to support healthcare delivery organization s HDO

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