Answer: b
The opposite is true. The names are easy to confuse, and caution is warranted. Many medication errors are the result of sound-alike drugs. There are several ways to help keep such drugs straight. One is to use "TALLman" lettering — the practice of writing the often-confused part of a drug's name in upper case letters — when labeling drugs or compartments. Also make sure look-alike, sound-alike drugs aren't stored next to each other, and place warnings on the storage bins to alert staff that the drugs are commonly confused. Repeating orders out loud to the prescriber is another standard precaution. Finally, the Institute for Safe Medication Practices (ISMP) regularly publishes a "List of Confused Drug Names" (tinyurl.com/aydrq). Keep the list at hand and highlight any drugs that are part of your facility's formulary.

Answer: drug strength; date it was drawn; time it was drawn; initials of preparer
Remember, too, that syringes should not be labeled until after they're drawn. Syringes that are pre-labeled for later fill are a dangerous opportunity for medication error. Buying pre-filled syringes from drug manufacturers is another way to safeguard medication delivery. The syringes come filled with the right medication and dose, and with pre-printed labels containing the standard labeling requirements, plus the drugs' lot numbers and expiration dates.

Answer: b
That dose of fentanyl would be lethal. The usual dose post-operatively is between 25 and 100 mcg. How important is it to distinguish between the abbreviations mg and mcg? A microgram is 1/1000th of a milligram. Be sure that your medication administrators have a firm grasp on both relative potencies and key abbreviations.

Answer: a
A kilogram is equal to about 2.2 pounds. If you don't have time to do the conversion, remember that the number of pounds a patient weighs is always a little more than 2 times the number of kilograms. The responsibility for dose validation may exist on several levels. In addition to the prescriber, nurses, pharmacists and anesthesia providers need to be aware when dosing of weight-based drugs needs to be calculated. Nurses involved in admissions should also be able to perform accurate conversions when patient weight is stated in pounds, which is usually the case.

Answer: a
When the expiration date is stated as month/year, it is understood to mean that the medication expires on the last day of that month. However, some drug companies choose to put a "1" in front of the month and year (for example, "1 June 15"). That results in an outdate on the first day of the month. Place stickers on boxes or mark the boxes directly with their expiration dates whenever feasible. It's also a good idea to remind staff, particularly those with medication management responsibilities, about the inconsistencies of manufacturer dating, and to work to standardize the dates in your storage area.

Answer: "cc" is best written as "ml" and ".5" is best written as "0.5."
As the ISMP points out, when written quickly by hand, "cc" can be mistaken for "u" and misunderstood as units, or worse, zeros. Additionally, dropping the lead zero in dosing documentation is a common and very avoidable root cause of errors that can lead to a 10-fold overdose, since ".5" can easily be mistaken for "5." Similarly, don't use a trailing zero, since, for example, "10.0" may be misread as "100," which could also result in a 10-fold overdose.

Answer: a
There's been a lot of pushback over the years because if you open a propofol vial that contains 200 mg and you use only 20 mg, it's troubling to discard the other 180 mg. But that's the standard. To avoid wasting expensive and scarce medications, consider purchasing agents in volumes closest to their usual usage patterns. Propofol has recently become available in 10-ml vials, to go along with 20- and 50-ml vials. Additionally, larger volumes may be available for infusion purposes in hospital settings. The 10-ml option will be advantageous for small dosing needs such as in ophthalmology, and might have prevented the devastating 2007 hepatitis C outbreak at the Endoscopy Center of Southern Nevada in Las Vegas, which occurred when staff repeatedly contaminated single-dose vials of propofol by using them as multi-dose vials. Also, if propofol ever becomes a controlled drug, there will be less waste, less time and fewer resources spent witnessing its disposal.

Answer: a
These look-alike, sound-alike drugs have been responsible for a disproportionate number of errors and some tragic results. In fact, the U.S. Department of Health and Human Services lists this mixup as one of the top 10 causing patient harm. Not only do the names sound alike, but some caregivers erroneously assume hydromorphone is the generic form of morphine. In fact, hydromorphone is up to 10 times more potent than morphine sulfate on a mg to mg basis.

Answer: b
Preservative-free medications are always single-use. There's no valid excuse for administering single-dose medications to multiple patients. Buying medications in single-dose units is preferred, but when using multiple-use containers, wipe them with alcohol swabs each time they're entered and store them according to the drug manufacturer's directives. Unless the manufacturer says otherwise, multi-use vials are good for use up to 28 days after the first entry. Note the expiration date on labels, not the date they were opened.