Specialty surgical attire; sharps safety program; surgical attire OR visitors; OR medication administration - Clinical Issues - operating room

AORN Journal,  March, 2002  by Carol Petersen

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Answer: Basic nursing principles for medication administration must be followed. The five "R's" of medication delivery include confirmation of the

* right patient,

* right medication,

* right dose,

* right route, and

* right time.

The circulating nurse should draw each medication into a syringe and deliver it aseptically to the sterile field. Stoppers should not be removed to pour the medication into a container on the sterile field.

All medications and medication containers (eg, syringes, medicine cups, basins) on the sterile field should be labeled even if there is only one container present. The label should include the name and strength of the medication. Labels can be made using an indelible sterile marking pen and self-adhesive wound approximating strips or commercially prepared sterile labels. The process of delivering, verifying, and labeling medication should be observed by both the circulating nurse and the scrub person accepting the medication onto the sterile field.

Facility policy should specify the process that OR personnel must follow for safe medication administration. Elements of a safe medication administration policy should include, but are not limited to,

* procedures for checking the medication, including who should check it before it is delivered to the sterile field;

* methods for labeling the medication on the sterile field; processes for verifying the labels on medications on the sterile field with original container label;

* protocols for how medications will be identified when passed to the surgeon; and

* techniques for verbal communication of medication strength and dosage.

A unique aspect of medication administration in the OR is that medication often is administered by the surgeon but prepared by the circulating nurse and scrub person. Medication use in the OR requires vigilance in following established safe medication practices. Careful adherence to safe medication administration in the OR is an important aspect of perioperative patient care.

NOTES

(1.) "Recommended practices for surgical attire," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2002) 2000.

(2.) A J Mangram et al, "Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee." American Journal of Infection Control 27 (April 1999) 112.

(3.) "Recommended practices for standard and transmission-based precautions in the perioperative practice setting," in Standards, Recommended Practices, and Guidelines (Denver: AORN, Inc, 2002) 321.

(4.) Occupational Safety and Health Administration, "Bloodborne pathogens--1910. 1030," http://www.osha-slc.gov/OshStd_data/1910_1030.html (accessed 21 Jan 2002).

(5.) T Kovach, "Controlling infection potentials when passing surgical instruments," Today's OR Nurse 15 (November/December 1993) 36-37.

(6.) Ibid.

(7.) "Recommended practices for surgical attire," 176.

(8.) Ibid, 175.