Recommended practices for safe care through identification of potential hazards in the surgical environment

AORN Journal,  March, 2003  

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5. To the extent possible, medications should be used in the strengths, dilutions, and/or dosages commercially available from the manufacturer. Strength, dilution, and dosage calculation charts should be immediately available in the OR at all times. Any medication calculation should be checked and verified by the RN and at least one other licensed, qualified individual before administration.

6. Medications should be delivered to the sterile field in an aseptic manner. Medications should not be poured on the sterile field unless the medication container is designed specifically for that purpose. Rubber stoppers should not be removed for the purpose of pouring the medication. Wipe the top of the stopper with an antiseptic agent according to facility policy and use the appropriate transfer devices (eg, syringe/needle, vial spike, filter straw) when delivering the medication to and mixing medication on the sterile field.

7. When medication is placed on the sterile field, the circulating nurse and scrub person should verify the medication label concurrently and audibly before and after the medication is placed on the field. Each person should view the label and verify the medication name, strength, dosage, and expiration date. When medication is procured for administration by the anesthesia care provider, the circulating nurse and anesthesia care provider should read the medication label aloud when the medication is transferred to the anesthesia care provider for administration.

8. Medications and/or containers (eg, syringes, medicine cups, basins) should be labeled at all times. A single medication should be prepared, delivered to the sterile field, and labeled by the scrub person before a second medication is prepared. The scrub person and circulating nurse should verify the labeled medication on the field concurrently, noting the medication name, strength, and dosage. The method of labeling may be determined by the facility. Sterile labels also are available commercially. All solutions on the sterile field, including medications, saline, and/or water, should be labeled. Original medication/ solution containers and delivery devices should be kept in the OR for reference until the conclusion of the procedure. Any unlabeled solution or medication, either on or off the sterile field, should be discarded.

9. If there is a change in either scrub or circulating personnel at any time during a procedure, all medications and their labels should be noted and verified concurrently by entering and exiting personnel.

10. When a medication is handed to the surgeon for administration, the name, strength, dilution, and/or dosage should be announced aloud so that all team members are aware of the medication being administered. As with verbal orders, use a digit by digit technique (ie, one-two as opposed to 12) to announce strength, dilution, and/or dosage to decrease the potential for error.

RECOMMENDED PRACTICE IV

Potential hazards associated with chemicals used in the practice setting should be identified, and safe practices should be established for their use.