Medication safety in the operating room: Literature and expert-based recommendations

J. A. Wahr, J. H. Abernathy, E. H. Lazarra, J. R. Keebler, M. H. Wall, I. Lynch, R. Wolfe, R. L. Cooper

Research output: Contribution to journalReview article

31 Scopus citations

Abstract

Human error poses significant risk for hospitalized patients causing an estimated 100,000 to 400,000 deaths in the USA annually. Medication errors contribute, with error occurring in 5.3% of medication administrations during surgery. In this study 70.3% of medication errors were deemed preventable. Given the paucity of randomized controlled studies, we undertook a rigorous review of the literature to identify recommendations supported by expert opinions. An extensive literature search pertaining to medication error, medication safety, operating room, and anaesthesia was performed. The National Guidelines Clearinghouse was searched for any anaesthesia or operating room medication safety guidelines. A total of 74 articles were included. Recommendations were tabulated and assigned points based on a scale revised from a prior study. A total of 138 unique recommendations were identified, with point tallies ranging from 4 to 190. An in-person focus meeting occurred, where the 138 recommendations were reviewed, combined and condensed. A modified Delphi process was used to eliminate items found to be unimportant or those unable to be quantified (e.g. "minimize fatigue"). A total of 35 specific recommendations remained. Adverse events as a result of medication errors occur frequently in the operative setting. There are few rigorous studies to direct medication safety strategies, but this should not lead us to do nothing. The overwhelming consensus regarding best practices should be accepted, and the recommendations implemented. Our list of recommended strategies can hopefully be used to assess local vulnerabilities and institute system solutions.

Original languageEnglish (US)
Pages (from-to)32-43
Number of pages12
JournalBritish Journal of Anaesthesia
Volume118
Issue number1
DOIs
StatePublished - 2017

Keywords

  • Anaesthesiology
  • Medication safety
  • Operating room

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Wahr, J. A., Abernathy, J. H., Lazarra, E. H., Keebler, J. R., Wall, M. H., Lynch, I., Wolfe, R., & Cooper, R. L. (2017). Medication safety in the operating room: Literature and expert-based recommendations. British Journal of Anaesthesia, 118(1), 32-43. https://doi.org/10.1093/bja/aew379