carefully thought out. Never arrange medications alphabetically; many
facilities arrange meds in the order they will be used in the case. Label
tray divisions clearly, and arrange the drugs so as to minimize confu-
sion. Rarely used drugs in the OR, if they're needed for a case, should
be kept in a unique location on top of the anesthesia cart, and
removed at the end of the case.
Single-use vials are preferable; if a multi-dose vial is required, it can
only be used for a single patient, and must be discarded at the end of
the case. There should be no concentrated drugs on trays if possible,
and if there are, they should contain an alert label, as should any high-
risk drugs like insulin or heparin.
Keep medications used to place regional or neuraxial blocks on
their own cart — absolutely keep them separate from IV meds.
Cognitive aids, checklists, rescue protocols and infusion rate charts
should all be on hand.
• Clear identification. Every medication prepared for administra-
tion should be labeled with the name, date and concentration. Read
and verify every vial, ampoule and syringe label before administra-
tion. Barcode technology with visual and auditory alerts or color-
coded labels can be used to help providers easily identify the correct
type or class of medication. Unfortunately, few ORs have implement-
ed medication bar code scanning, even though it has been shown to
reduce errors.
When labeling syringes, do not use abbreviations and watch out
for "zero issues" — never use trailing zeroes (such as 5.0, which can
be confused for 50) but always use leading zeroes (say, 0.5 instead
of .5, which can be misread as 5). Never administer a medication in
an unlabeled syringe.
Pass only a single med at a time into the sterile field, with 2 mem-
bers of the surgical team checking and verifying that the correct
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