A LOT TO LABEL In addition to the name and strength of medications contained within, labels for predrawn syringes must have the date, time and initials of the preparer.

Unlabeled medications and solutions on the sterile field can have negative, even deadly, outcomes. Take this tragic incident, for example. An anesthesiologist accidentally gave a patient who'd just had his cancerous eye enucleated an intrathecal injection of glutaraldehyde from an unlabeled specimen cup. The anesthesiologist thought he was giving the patient the spinal fluid he had aspirated before surgery to decrease the patient's cerebral pressure, as the malignancy had spread to the brain. He had placed the spinal fluid in a small vial marked "SF" on the sterile field for reinjection at the end of the surgery.

How did this mixup occur? As detailed in the July 1989 "Medication Error Reports" in Hospital Pharmacy, when an ophthalmology resident entered the room to retrieve the eye for biopsy, the specimen wasn't yet ready to be taken, so he left the specimen storage container on the sterile field and left the OR. The unlabeled container, which was identical to the cup holding the spinal fluid, contained glutaraldehyde to preserve the eye.

Are your patients protected?
Could something like that occur at your facility? Unless you've implemented a medication labeling process to prevent untoward outcomes and minimize errors, it could. In 2006, the Joint Commission focused attention on medication labeling and issued a National Patient Safety Goal, which directed healthcare providers to immediately label all medications, medication containers (syringes, cups, basins) and any other solutions on or off the sterile field in any perioperative or procedural setting. One year later, the Joint Commission stated that all labels should include the medication name, strength, amount and expiration date. This is required even if only 1 medication solution is on the sterile field. AORN recommends that nurses take the following intraoperative steps:

• demonstrate an understanding of the medication;
• prepare the medication as close as possible to usage;
• use proper handoff technique when delivering the medication to the sterile field; and
• immediately label the secondary container, confirm the dose and verify the medication.

Your action plan
Here are a few products and practices that can reduce the risk of a medication error by making it easy to identify what's on the sterile field.

• Pharmacy involvement. A pharmacist can review orders, prepare solutions, oversee dispensing and improve communication. Pharmacists can also standardize medications and doses to help prevent provider ordering errors.
• Pre-made labels. Pre-made labels should be formatted reflective of the requirements of the Joint Commission and AORN recommendations. Made of a moisture- and smear-resistant polyester material that won't tear or fall off even if they get wet, premade labels should provide proper nomenclature, medication dose and concentration to prevent errors resulting from illegible handwriting and deviation from standard protocols. Safe label systems (tinyurl.com/b8pmvdl) are also available to print labels with bar codes for electronic documentation that are adhered to the syringe. This can save time for charge capture and prevent medication errors by using clear, pre-printed labels. Yet another option is to use an automated dispensing cabinet that generates a patient-specific, printed label containing all the necessary identifying information at the time you remove the item from the cabinet.
• Ready-to-use and premixed medications. Ready-to-use forms of medications are sterile preparations that can help prevent errors. These medications can be commercially prepared or produced in-house depending upon the preferences of the institution. Pre-mixed medications and mixed patient-specific medications help avoid preparation errors. Your pharmacist can prepare these items upon request.
• Pre-filled syringes. They can prevent medication errors, enhance medication safety and decrease drug waste. You can also prepare pre-filled syringes in-house. Labels for pre-drawn syringes must have the date, time and initials of the preparer in addition to the name and strength of medications contained within.

Part of your culture
There are many distractions in the OR (tinyurl.com/b9jzxbv), emergent situations and turnover pressures to contend with that can lead to medication errors. Always check, recheck and be fully present during all medication administrations. Make safe labeling part of your facility's culture by setting practical guidelines, auditing clinical practice and using products to make the job easier.