tices. A recent visit to a high-volume pain management facility with a
short-staffed anesthesia department presented many examples of major
breaches in safe injection practices that could endanger patients. We
share them here in the hopes that you don't repeat these practices.
Injectable medications previously drawn up in direct patient care
areas were left on top of the anesthesia cart. Medications includ-
ed sodium chloride and a syringe with a white milky substance (pre-
sumably propofol). We found them in an unattended operating room
between procedures. Of course, proper practice is to store and access
injectables in a non-patient care area if you're going to use them for
more than one patient.
An anesthesiologist carried a basket with several filled syringes
— as well as some empty syringes that had been removed from
their packages — from room to room. All syringes (empty and filled)
had syringe caps on them, but filled syringes had been drawn up in
the rooms (direct patient care areas) in advance of cases.
An anesthesiologist carried a multi-dose vial of propofol with a
spiking device in the basket back and forth between rooms. Pre-
drawing medications and spiking IV bags as close to administration as
possible is best practice. Spiking devices is not good practice.
We found an opened, unlabeled multi-dose vial of labetalol in the
procedure room anesthesia cart.
Anesthesiologists failed to wipe the rubber diaphragm of the vial
with alcohol before drawing up medication. And then they failed to
"scrub" the IV port, or hub, with alcohol before injecting medication.
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