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Did Skin Prep Fuel This Fire? - February 2017 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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1 4 • O U T PA 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 1 7 W hen the pre-printed labels affixed to your medication stor- age bins and syringes don't match the contents of the drug that's stored inside, a serious medication error is just wait- Can You Spot These 7 Medication Label Errors? • EPHEDRINE BAG The ephedrine bag simply does not reveal the strength of ephedrine within the IV bag. • EPHEDRINE This ampule of ephedrine is 50 mg/mL, but the label states 10 mg/mL. This is a seriously fertile opportunity for a significant med error due to this 5-fold difference. • FENTANYL The fentanyl label, as provided by the printer and not reviewed by the facility, indicates 50 mg/mL. It's really 50 micrograms per mL, not milligrams. • ATROPINE Another dangerous error waiting to happen with a high-alert medication. The strength on the pre-printed syringe label doesn't match the manufacturer's vial label. • PHENYLEPHRINE This adrenergic agonist is a high-alert medication, meaning the consequences of an error are more devastating. The product is 10 mg/mL, not 10 mg/10mL as the label indicates. In a crisis, we have a potential underdose. • FLUMAZENIL This vial of benzodiazepine reverser is 0.1 mg/mL, not 0.5 mg/mL as the label indicates. Theoretically, a patient in crisis requiring reversal would be underdosed should this potential error occur. • NEOSTIGMINE The pre-printed label indicates 1 mg/mL, but the vial contains 0.5 mg/mL. This is a 100% differential for this potent medication, which is used with atropine to end the effects of neuromuscular-blocking drugs.

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