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Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie 2/2013

01-02-2013 | Review Article/Brief Review

Review article: Improving drug safety for patients undergoing anesthesia and surgery

Authors: Beverley A. Orser, MD, PhD, Sylvia Hyland, MHSc, David U, MSc, Ian Sheppard, BScPhm, C. Ruth Wilson, MD

Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 2/2013

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Abstract

Purpose

This article presents a summary of recent advances, including tools and interventions, that are designed to improve drug safety for patients in critical care settings, particularly those undergoing anesthesia and surgery.

Principal findings

Medication error remains a leading cause of adverse events among patients undergoing anesthesia. Misidentification of ampoules, vials, and syringes is a common source of error. Systems are now being engineered to reduce the likelihood of medication misidentification through approaches such as revision of standards for labelling of drug ampoules and vials and the development of bar code systems that allow “double checking” or drug verification in the operating room. Also, efforts are being made to improve medication reconciliation, a process for accurately communicating a patient’s medication information during transitions from one healthcare setting to another. Finally, the opportunity exists for anesthesiologists to increase awareness about the rising problem of opioid addiction in patients for whom typical doses are initially prescribed for appropriate indications such as postoperative pain.

Conclusions

There is a need to improve drug delivery systems in complex critical care environments, particularly the operating room. Anesthesiologists must continue to play a leading role in promoting drug safety in these environments.
Footnotes
1
National Health Service (U.K.): Institute for innovation and improvement. Reducing avoidable deaths: chief executives. June 2007.
 
2
CAN/CSA-Z264.2-99 (R2009) Labelling of drug ampoules, vials, and prefilled syringes. Mississauga, (ON): CSA Group; 1999 [reaffirmed 2009].
 
3
Drug packaging and labelling guidelines for manufacturers. (ON) Canadian Society for Hospital Pharmacists: 2001.
 
4
“International Medication Safety Network [homepage]; Horsham (PA)” Available from http://​www.​intmedsafe.​net/​Contents/​Home.​aspx.
 
5
ISO 26825:2008, Anaesthetic and respiratory equipment – user-applied labels for syringes containing drugs used during anesthesia – colours, design and performance. Geneva (Switzerland): International Organization for Standardization; 2008.
 
6
CAN/CSA-ISO 26825-10, Anaesthetic and respiratory equipment – user-applied labels for syringes containing drugs used during anesthesia – colours, design and performance. Mississauga (ON): CSA Group; 2010.
 
7
Wideman MV, Whittler ME, Anderson TM. Barcode medication administration: lessons learned from an intensive care unit implementation. Advances in patient safety: from research to implementation (Volume 3: Implementation issues). Rockville (MD): Agency for Healthcare Research and Quality (US); 2005 Feb.
 
8
Juurlink DN, Dhalla I. Dependence and addiction during chronic opioid therapy. J Med Toxicol. E-pub ahead of Print. October 2012.
 
Literature
1.
go back to reference Baker GR, Norton PG, Flintoft V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004; 170: 1678-86.PubMed Baker GR, Norton PG, Flintoft V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004; 170: 1678-86.PubMed
2.
3.
go back to reference Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety: an elusive target. JAMA 2006; 296: 696-9.PubMedCrossRef Pronovost PJ, Miller MR, Wachter RM. Tracking progress in patient safety: an elusive target. JAMA 2006; 296: 696-9.PubMedCrossRef
4.
go back to reference Auerbach AD, Landefeld CS, Shojania KG. The tension between needing to improve care and knowing how to do it. N Engl J Med 2007; 357: 608-13.PubMedCrossRef Auerbach AD, Landefeld CS, Shojania KG. The tension between needing to improve care and knowing how to do it. N Engl J Med 2007; 357: 608-13.PubMedCrossRef
5.
go back to reference Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274: 29-34.PubMedCrossRef Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA 1995; 274: 29-34.PubMedCrossRef
6.
go back to reference Denham CR. TRUST: The 5 rights of the second victim. J Patient Saf 2007; 3: 107-19.CrossRef Denham CR. TRUST: The 5 rights of the second victim. J Patient Saf 2007; 3: 107-19.CrossRef
7.
go back to reference Cooper L, DiGiovanni N, Schultz L, Taylor AM, Nossaman B. Influences observed on incidence and reporting of medication errors in anesthesia. Can J Anesth 2012; 59: 562-70.PubMedCrossRef Cooper L, DiGiovanni N, Schultz L, Taylor AM, Nossaman B. Influences observed on incidence and reporting of medication errors in anesthesia. Can J Anesth 2012; 59: 562-70.PubMedCrossRef
8.
go back to reference Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494-500.PubMed Webster CS, Merry AF, Larsson L, McGrath KA, Weller J. The frequency and nature of drug administration error during anaesthesia. Anaesth Intensive Care 2001; 29: 494-500.PubMed
10.
go back to reference Fasting S, Gisvold SE. Adverse drug errors in anesthesia, and the impact of coloured syringe labels. Can J Anesth 2000; 47: 1060-7.PubMedCrossRef Fasting S, Gisvold SE. Adverse drug errors in anesthesia, and the impact of coloured syringe labels. Can J Anesth 2000; 47: 1060-7.PubMedCrossRef
11.
go back to reference Sakaguchi Y, Tokuda K, Yamaguchi K, Irita K. Incidence of anesthesia-related medication errors over a 15-year period in a university hospital. Fukuoka Igaku Zasshi 2008; 99: 58-66.PubMed Sakaguchi Y, Tokuda K, Yamaguchi K, Irita K. Incidence of anesthesia-related medication errors over a 15-year period in a university hospital. Fukuoka Igaku Zasshi 2008; 99: 58-66.PubMed
12.
go back to reference Jensen LS, Merry AF, Webster CS, Weller J, Larsson L. Evidence-based strategies for preventing drug administration errors during anaesthesia. Anaesthesia 2004; 59: 493-504.PubMedCrossRef Jensen LS, Merry AF, Webster CS, Weller J, Larsson L. Evidence-based strategies for preventing drug administration errors during anaesthesia. Anaesthesia 2004; 59: 493-504.PubMedCrossRef
13.
go back to reference Orser BA, Chen RJ, Yee DA. Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 2001; 48: 139-46.PubMedCrossRef Orser BA, Chen RJ, Yee DA. Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 2001; 48: 139-46.PubMedCrossRef
14.
go back to reference Wheeler SJ, Wheeler DW. Medication errors in anaesthesia and critical care. Anaesthesia 2005; 60: 257-73.PubMedCrossRef Wheeler SJ, Wheeler DW. Medication errors in anaesthesia and critical care. Anaesthesia 2005; 60: 257-73.PubMedCrossRef
15.
go back to reference Currie M, Mackay P, Morgan C, et al. The Australian Incident Monitoring Study. The “wrong drug” problem in anaesthesia: an analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 596-601.PubMed Currie M, Mackay P, Morgan C, et al. The Australian Incident Monitoring Study. The “wrong drug” problem in anaesthesia: an analysis of 2000 incident reports. Anaesth Intensive Care 1993; 21: 596-601.PubMed
16.
17.
go back to reference Merry AF, Peck DJ. Anaesthetists, errors in drug administration and the law. N Z Med J 1995; 108: 185-7.PubMed Merry AF, Peck DJ. Anaesthetists, errors in drug administration and the law. N Z Med J 1995; 108: 185-7.PubMed
18.
go back to reference Orser BA. Medication safety in anesthetic practice: first do no harm. Can J Anesth 2000; 47: 1051-4.PubMedCrossRef Orser BA. Medication safety in anesthetic practice: first do no harm. Can J Anesth 2000; 47: 1051-4.PubMedCrossRef
19.
go back to reference Orser BA, Byrick R. Anesthesia-related medication error: time to take action. Can J Anesth 2004; 51: 756-60.PubMedCrossRef Orser BA, Byrick R. Anesthesia-related medication error: time to take action. Can J Anesth 2004; 51: 756-60.PubMedCrossRef
20.
go back to reference Abeysekera A, Bergman IJ, Kluger MT, Short TG. Drug error in anaesthetic practice: a review of 896 reports from the Australian Incident Monitoring Study database. Anaesthesia 2005; 60: 220-7.PubMedCrossRef Abeysekera A, Bergman IJ, Kluger MT, Short TG. Drug error in anaesthetic practice: a review of 896 reports from the Australian Incident Monitoring Study database. Anaesthesia 2005; 60: 220-7.PubMedCrossRef
21.
go back to reference Short TG, O’Regan A, Lew J, Oh TE. Critical incident reporting in an anaesthetic department quality assurance programme. Anaesthesia 1993; 48: 3-7.PubMedCrossRef Short TG, O’Regan A, Lew J, Oh TE. Critical incident reporting in an anaesthetic department quality assurance programme. Anaesthesia 1993; 48: 3-7.PubMedCrossRef
26.
go back to reference Paoletti RD, Suess TM, Lesko MG, et al. Using bar-code technology and medication observation methodology for safer medication administration. Am J Health Syst Pharm 2007; 64: 536-43.PubMedCrossRef Paoletti RD, Suess TM, Lesko MG, et al. Using bar-code technology and medication observation methodology for safer medication administration. Am J Health Syst Pharm 2007; 64: 536-43.PubMedCrossRef
27.
go back to reference Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med 2010; 362: 1698-707.PubMedCrossRef Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. N Engl J Med 2010; 362: 1698-707.PubMedCrossRef
28.
go back to reference Morriss FH Jr, Abramowitz PW, Nelson SP, et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. J Pediatr 2009; 154: 363-8.PubMedCrossRef Morriss FH Jr, Abramowitz PW, Nelson SP, et al. Effectiveness of a barcode medication administration system in reducing preventable adverse drug events in a neonatal intensive care unit: a prospective cohort study. J Pediatr 2009; 154: 363-8.PubMedCrossRef
33.
go back to reference Merry AF, Webster CS, Hannam J, et al. Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomized clinical evaluation. BMJ 2011; DOI: 10.1136/bmj.d5543. Merry AF, Webster CS, Hannam J, et al. Multimodal system designed to reduce errors in recording and administration of drugs in anaesthesia: prospective randomized clinical evaluation. BMJ 2011; DOI: 10.​1136/​bmj.​d5543.
34.
go back to reference Fung E. Point-of-care medication bar-coding system in the OR. Pharmacy Practice 2009; (April): 1-6. Fung E. Point-of-care medication bar-coding system in the OR. Pharmacy Practice 2009; (April): 1-6.
35.
go back to reference Gray SL, Mahoney JE, Blough DK. Adverse drug events in elderly patients receiving home health services following discharge. Ann Pharmacother 1999; 33: 1147-53.PubMedCrossRef Gray SL, Mahoney JE, Blough DK. Adverse drug events in elderly patients receiving home health services following discharge. Ann Pharmacother 1999; 33: 1147-53.PubMedCrossRef
36.
go back to reference Bell CM, Bajcar J, Bierman AS, Li P, Mamdani MM, Urbach DR. Potentially unintended discontinuation of long-term medication use after elective surgical procedures. Arch Intern Med 2006; 166: 2525-31.PubMedCrossRef Bell CM, Bajcar J, Bierman AS, Li P, Mamdani MM, Urbach DR. Potentially unintended discontinuation of long-term medication use after elective surgical procedures. Arch Intern Med 2006; 166: 2525-31.PubMedCrossRef
37.
go back to reference Rozich JD, Resar RK. Medication safety: one organization’s approach to the challenge. J Clin Outcomes Manage 2001; 8: 27-34. Rozich JD, Resar RK. Medication safety: one organization’s approach to the challenge. J Clin Outcomes Manage 2001; 8: 27-34.
38.
go back to reference Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med 2007; 167: 1034-40.PubMedCrossRef Kwan Y, Fernandes OA, Nagge JJ, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med 2007; 167: 1034-40.PubMedCrossRef
39.
go back to reference Leung V, Mach K, Charlesworth E, Hicks S, Kizemchuk K, Stumpo C. Perioperative Medication Management (POMM) pilot: integrating a community-based medication history (MedsCheck) into medication reconciliation for elective orthopaedic surgery inpatients. Canadian Pharmacists Journal 2010; 143: 82-7.CrossRef Leung V, Mach K, Charlesworth E, Hicks S, Kizemchuk K, Stumpo C. Perioperative Medication Management (POMM) pilot: integrating a community-based medication history (MedsCheck) into medication reconciliation for elective orthopaedic surgery inpatients. Canadian Pharmacists Journal 2010; 143: 82-7.CrossRef
40.
go back to reference Fernandes OA. Medication reconciliation. Pharmacy Practice 2009; (October): 24-32, 52-5. Fernandes OA. Medication reconciliation. Pharmacy Practice 2009; (October): 24-32, 52-5.
41.
go back to reference Schnipper J, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med 2006; 166: 565-71.PubMedCrossRef Schnipper J, Kirwin JL, Cotugno MC, et al. Role of pharmacist counseling in preventing adverse drug events after hospitalization. Arch Intern Med 2006; 166: 565-71.PubMedCrossRef
48.
go back to reference Centers for Disease Control and Prevention. CDC grand rounds: prescription drug overdoses — a U.S. epidemic. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 2012; 61: 10-3. Centers for Disease Control and Prevention. CDC grand rounds: prescription drug overdoses — a U.S. epidemic. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report 2012; 61: 10-3.
49.
go back to reference Gomes T, Mamdami MM, Dhalla I, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med 2011; 171: 686-91.PubMedCrossRef Gomes T, Mamdami MM, Dhalla I, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med 2011; 171: 686-91.PubMedCrossRef
51.
go back to reference Lange M, Van Aken H, Westphal M, Morelli A. Role of vasopressinergic V1 receptor agonists in the treatment of perioperative catecholamine-refractory arterial hypotension. Best Pract Res Clin Anaesthesiol 2008; 22: 369-81.PubMedCrossRef Lange M, Van Aken H, Westphal M, Morelli A. Role of vasopressinergic V1 receptor agonists in the treatment of perioperative catecholamine-refractory arterial hypotension. Best Pract Res Clin Anaesthesiol 2008; 22: 369-81.PubMedCrossRef
52.
go back to reference Coriat P, Richer C, Douraki T, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994; 81: 299-307.PubMedCrossRef Coriat P, Richer C, Douraki T, et al. Influence of chronic angiotensin-converting enzyme inhibition on anesthetic induction. Anesthesiology 1994; 81: 299-307.PubMedCrossRef
53.
go back to reference Mekontso-Dessap A, Houel R, Soustelle C, Kirsch M, Thebert D, Loisance DY. Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg 2001; 71: 1428-32.PubMedCrossRef Mekontso-Dessap A, Houel R, Soustelle C, Kirsch M, Thebert D, Loisance DY. Risk factors for post-cardiopulmonary bypass vasoplegia in patients with preserved left ventricular function. Ann Thorac Surg 2001; 71: 1428-32.PubMedCrossRef
55.
go back to reference Hazlet TK, Lee TA, Hansten PD, Horn JR. Performance of community pharmacy drug interaction software. J Am Pharm Assoc 2001; 41: 200-4. Hazlet TK, Lee TA, Hansten PD, Horn JR. Performance of community pharmacy drug interaction software. J Am Pharm Assoc 2001; 41: 200-4.
Metadata
Title
Review article: Improving drug safety for patients undergoing anesthesia and surgery
Authors
Beverley A. Orser, MD, PhD
Sylvia Hyland, MHSc
David U, MSc
Ian Sheppard, BScPhm
C. Ruth Wilson, MD
Publication date
01-02-2013
Publisher
Springer-Verlag
Published in
Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Issue 2/2013
Print ISSN: 0832-610X
Electronic ISSN: 1496-8975
DOI
https://doi.org/10.1007/s12630-012-9853-y

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