Safe Medication Administration
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ASPAN Position Statement
Safe Medication Administration

The American Society of PeriAnesthesia Nurses (ASPAN) has a responsibility to define principles of safe, quality nursing practice in the perianesthesia setting. ASPAN, therefore, has the responsibility to assist in defining and supporting guidelines for the safe administration of medications within perianesthesia nursing practice.

Background

Healthcare today is riddled with issues associated with nursing staff shortages, utilization of temporary or agency staff, chal­lenging technological and scientific advances, and characteristics of a “drive-by” culture which include increased volumes and complexities of same day surgeries as well as clinical fast tracking. As a result, the following issues have been identified:

  1. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) publishes annual patient safety goals, which include recommendations for improving the safe administration of medications. A number of healthcare and consumer organizations have also offered their endorsement of safer practice environments including the Agency for Healthcare Research and Quality, the American Society of Health-System Pharmacists, the Institute for Safe Medication Practices, and the National Quality Forum to name a few.
  2. Medication use has always been extremely beneficial but always with risk.
  3. In spite of any number of clinical practice safety measures, professional and personal accountability cannot be eliminated.
  4. ASPAN’s Clinical Practice Committee has received numerous inquiries related to the appropriateness of peri­anesthesia nurses administering drugs typically classified as anesthetic agents (propofol, ketamine, methohexi­tal) for non-surgical situations. While over the last few years these drugs have been used in critical care settings for the purposes of sedation of the mechanically ventilated patient, they are now being introduced for nursing staff to administer to provide sedation for short-term therapeutic, diagnostic, or surgical procedures or as an adjuvant to antiemetic protocols.

Position

It is therefore the position of ASPAN that the perianesthesia nurse is responsible for providing the safe administration of medications wherever perianesthesia care is delivered. Guidelines for the safe administration of medications ought to include the following principles:

  1. Patient safety is the highest priority.
  2. Perianesthesia RNs are accountable for knowing their State Nurse Practice Act.
  3. Perianesthesia RNs are accountable for knowing ASPAN’s resource: The Role of the Registered Nurse in the Management of Patients Undergoing Sedation for Short-Term, Therapeutic, Diagnostic or Surgical Procedures.
  4. Perianesthesia RNs are professionally accountable for having knowledge of any medications administered to include indications, action, administration, side effects and treatment of untoward reactions. This includes maintaining core competencies within the scope of perianesthesia nursing practice. “No one can be expected to carry out a dangerous task safely for which he or she has not been trained.”1
  5. Perianesthesia RNs are accountable for patient outcomes resulting from the administration of these agents. This accountability includes the reporting of clinical trends as outlined by the facility’s process.
  6. Perianesthesia RNs are responsible to know and implement facility policies related to the administration of medications.
  7. Written medication guidelines should be the result of collaboration between physicians, pharmacists and nurs­es and should be evidence-based. These guidelines should include, but not be limited to, the following accredi­tation requirements:
    1. Abbreviations and symbols should be standardized.
    2. Patient identification processes must include at least two identifiers.
    3. High-alert medications can easily be identified within the facility.
    4. Whenever in use, intravenous infusion pumps include free-flow protection devices.
    5. Appropriate communication resources are practiced concerning patient allergy and drug reaction history.
    6. Perianesthesia nurses can readily access updated pharmacological references as well as timely education to introduce new medications.
    7. Work environments restrict unnecessary noise and distractions from the medication preparation area.
    8. Follow recommended national patient safety goals regarding verbal and telephone orders.

Expected Outcomes

Perianesthesia nurses need to familiarize themselves with this position statement and inform and educate peers, nurse man­agers, hospital administrators and physicians.

Collaborative and multidisciplinary efforts must be made to define and implement safe medication administration guide­lines wherever perianesthesia nurses provide care.

ASPAN, as the voice of perianesthesia nursing practice, must externalize this information by sharing this position statement with regulatory agencies and other related professional organizations.

Approval of Statement

This statement was recommended by a vote of the ASPAN Board of Directors on April 17, 2004, in Philadelphia, Pennsylvania, and approved by a vote of the ASPAN Representative Assembly on April 18, 2004, in Philadelphia, Pennsylvania.

Reference
Pharmacy – nursing shared vision for safe medication use in hospitals: Executive session summary. Am J Health-Syst Pharm, 60, May 15, 2003. Available at www.ashp.org/. Accessed January 2004.

Bibliography

  1. 2006 National Patient Safety Goals, Joint Commission on Accreditation of Healthcare Organizations. Available at www.jcaho.org. Accessed September 12, 2005Tools for Patient Safety, The Agency for Healthcare Research and Quality. Available at www.ahrq.gov/. Accessed September 12, 2005
  2. Organizations Release New Tools For Reducing Medication Errors, the Institute for Safe Medication Practices. Available at www.ismp.org/. September 12, 2005.
  3. NQF-Endorsed Set of Safe Practices, the National Quality Forum. Available at www.qualityforum.org last accessed September 12, 2005.
  4. Medication Errors, US Food and Drug Administration Patient Safety News. US Food and Drug Administration. Available at www.fda.gov/cder/drug/MedErrors/default.htm last accessed September 12, 2005.
  5. AANA/ASA Joint Statement Regarding Propofol Administration. Available at www.aana.com. September 12, 2005.
  6. How to prevent medication errors, the Institute for Safe Medication Practices. Available at www.ismp.org/PDF/Patient_Broc.pdf last accessed September 12, 2005.
  7. Medication Errors in Post Anesthesia Care Units, U.S. Pharmacopeia (USP). Available at www.usp.org/patientSafety/resources/posters/posterPostAnesthesiaCU.html last accessed September 12, 2005.
 
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