Keep in mind that guidelines
issued by the American Society
of Anesthesiologists say all labels
on vials and ampoules must con-
tain the drug's generic name, con-
centration, total volume or con-
tents, manufacturer, lot number,
date of manufacturing and expi-
ration date. Additionally,
providers must note the drug,
strength, date and their initials on
labels affixed to syringes that will
be used in the OR.
7. A patient indicates a "signifi-
cant allergy" to Percocet on an
admission report. The PRN list
for pain management lists sever-
al drugs and looks like the
example below (the checkmarks
indicate the prescriber's
endorsed orders). What's your
next step?
• If the patient cannot take
Percocet, administer fentanyl
50 mcg x1; may repeat in 15
minutes one time only
• Oxycodone with APAP x1 as
needed one time only
• Tramadol 50 mg PRN
for pain
• Acetaminophen with
Codeine #3 PRN for pain
• Dilaudid 2 mg PO x1 if oxy-
codone/APAP is ineffective
Answer: Call the prescriber.
Oxycodone with APAP is
Percocet. If a patient is allergic
to Percocet, then oxycodone
with APAP is the same thing.
"This example reaffirms the need
to correlate stated allergies and
side effect declarations to
endorsed medication orders,"
says Mr. Sones.
5 0 • O U T P A T I
E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 2 1
Answer: These various medications need to be separated. Mr. Sones
says drug storage areas must not allow for "intermingling" of a number
of different agents. The epinephrine vials shown in this photo contain
different concentrations, which could lead to confusion when they're
pulled for use. Allocating sufficient space for drug storage allows for
segregation of each drug and concentration, points out Mr. Sones.
He emphasizes that concentrated electrolytes should be stored
away from other inventory to help ensure staff are aware the solu-
tions need to be diluted before administration. Mr. Sones also says
neuromuscular blockers should be stored in separate lidded contain-
ers or a secured storage area. Additionally, according to a safety alert
issued by the Institute for Safe Medication Practices (ISMP), neuro-
muscular blockers should be kept only in areas where they are rou-
tinely needed. Warning labels should be placed on their storage con-
tainers to alert staff of the risk of respiratory paralysis and the need
to ventilate patients who receive them, recommends the alert.
OSM
8. How should you address the
potential for error shown in this picture?
Sheldon
Sones