Safe Management and Use of Medications

Safe administration of medicine involves:

• Timely administration
• Prevention of drug errors
  Anaesthetists are often solely responsible for prescription, preparation, dispension, and labelling of drugs.
  • Correct:
    • Patient
    • Dose
    • Route
    • Time
  • Awareness of human factors that contribute to drug errors
• Accurate recording of drugs used
• Minimisation of drug misdirection

Purchasing Decisions

Consideration should be placed towards:

• Accurate labelling and packaging, facilitating identification
• Segration of drugs with different concentrations but similar physical preparation
• Minimising need for dilution prior to use
  • Consider pre-diluting dangerous drugs to levels safe for administration

Storage

Considerations:

• Drugs with abuse potential should be locked when access is not required
• Emergency drugs should be immediately accessible
  These include:
  • Adrenaline
  • Vasopressors
  • Propofol
  • Muscle relaxants
  • Local anaesthetics
• Drug draws should be organised formally
  Standardisation within each institution and region is desirable.
• Drugs with similar appearances and names (but in different classes) should be stored separately
• Drugs should be stored in ways to minimise error

Labelling

Labels:

• Should be applied to all drawn-up injectable drugs
• Should be legible
• Should be colour-coded by class
• Are only not required when:
  • Preparation and bolus administration is a single uninterrupted process
  • The syringe does not leave the hands of the person who prepared it
  • The person who prepared it administers it immediately

Administration

• Every patient receiving a drug should be identified prior to administration
• Prescriptions must be legible, and contain:
  • Drug name
  • Dose
  • Route
  • Dose interval and time
  • Any special instructions
• Uncluttered surface space should be available for drawing up, arranging, and holding drugs
  • Emergency drugs should be located separately
• Empty ampoules should be retained for checking in case of an adverse event or administration error
• Time between drawing up and administering should be minimised

Infusion Pumps

Should be:

• Standardised within an institution
• Fitted with one-wayu valves to prevent siphoning of inufsed drug
  • Luer-lock connections should be used where possible
• Different from those used for neuraxial and peripheral nerve catheters

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References

1. ANZCA. PS51: Guidelines for the Safe Management and Use of Medications in Anaesthesia.