minds and daily actions of your staff.
Embrace checklists
Checklists are helpful when unfamiliar medications are being
given. Over time, resistance to checklists has decreased as OR teams
have adopted them into time-out procedures. Take advantage of their
use of pre-op checklists to have them identify and discuss the admin-
istration of seldom-used medications before procedures start.
Technology enhancers
Having medications supplied in ready-to-use form eliminates
issues regarding purity and labeling. Adopting barcode scanners that
interface with electronic records provides support and safety checks
for medication management. Barcode devices must interface with anes-
thesia information monitoring systems (AIMS) to be maximally effective.
Ideally, they need to annunciate the medication as it's scanned. At the
AIMS end of the system, software should intervene with warnings when
contraindicated medications are about to be given. In addition, barcode
reading needs to be incorporated into syringe pumps with the same
goals in mind. Unfortunately, while the technology exists for intelligent
systems that could prevent a variety of errors, manufacturers of AIMS
and EHR systems have little motivation to add it to their systems, and
hospitals have little motivation to pay more for it. I believe this is
shortsighted and does not account for the entire cost of care. Medical
errors are treated as an anomaly, whereas the consequences of errors
can be quite expensive, both in terms of increased healthcare costs
and patient suffering.
OSM
Dr. Cohen (jcohen@anest.ufl.edu) is an associate professor emeritus of
anesthesiology at the University of Florida in Gainesville.
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