New AORN Recommendations Include Discontinuing Use of Multidose Vials

Following months of research and evaluation, the Association of periOperative Registered Nurses (AORN) has released Recommended practices for medication safety. Available in the associations newly released 2012 edition of Perioperative Standards and Recommended Practices, the medication safety recommended practice (RP) supports positive outcomes and quality patient care before, during and after surgery.

Medication safety has become increasingly important as state and federal inspections are focusing on safe injection practices and accreditation organizations focus on national goals aimed at reducing medication errors. In the past, perioperative nurses may have watched closely for errors while medications are being administered. But the 2005 MEDMARX® Data Report revealed that errors at the point of care often stem from mistakes that took place earlier in the medication use process.

Recommended practices for medication safety outlines best practices for all six phases of medication use: Procuring, prescribing, transcribing, dispensing, administering and monitoring.

As with all published AORN RPs, the medication safety review process included a 30-day public comment period, at which time comments were submitted by perioperative nurses from across the United States, as well as representatives from ANA, ASA, AANA, the FDA, and the Institute for Safe Medication Practices (ISMP). The new RP includes a multidisciplinary approach and can be used by all members of the perioperative team in all perioperative practice settings.

This medication safety RP expands the description of medication safety by looking at broader risk points in the life of a medication from the point of storage through to the point of disposal of the medication after it has been given, says Bonnie Denholm, MS, BSN, RN, CNOR, AORN perioperative nursing specialist and lead author of the RP.

According to Ramona Conner, MSN, RN, CNOR, manager of AORN's standards and recommended practices, the recommendation that intravenous solution containers be punctured as close as possible to time of use is controversial because it may impact efficiency. She also anticipates that some OR personnel may disagree with the recommendation against the use of multidose vials because they are a cost-saving measure, but with the new RP, evidence indicates they pose a risk of cross contamination.

We have received quite a few inquiries about outbreaks that have been reported relating to the use of multidose vials and syringes, Conner explains. It was important that this RP lay it out, be very specific and provide comprehensive guidance.

Other key recommendations in this RP address:
- Taking a multidisciplinary team approach that includes pharmacist involvement in the perioperative medication management process.
- Developing systems to evaluate compliance with safe practices at each step in the medication use process.
- Assessing patients before and after administering medication.
- Using aseptic technique when transferring medications to the sterile field and during incremental injections.

Also new in the 2012 edition of Perioperative Standards and Recommended Practices are recommended practices for the Prevention of Deep Vein Thrombosis and Perioperative Health Care Information Management. These RPs were released in 2011 and are now available for the first time in book and CD formats. The medication safety RP will be available on CD in February.
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