cated and skilled workforce, state-of-the-art tech- ... online Examination and Learner Evaluation at .... nologists (eg, radiology, cardiovascular, perfu- ..... The behavioral objectives and examination for this program were prepared by ... AORN is accredited as a provider of continuing nursing education by the American Nurses ...
Perioperative Pharmacology: A Framework for Perioperative Medication Safety 1.6 RODNEY W. HICKS, PhD, RN, FNP-BC, FAANP, FAAN; LINDA WANZER, MSN, RN, CNOR; BRADLEE GOECKNER, MSN, RN, CNOR
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ABSTRACT Learning pharmacology is a critical element of any health care practitioner’s education to ensure quality and safety in perioperative care. The medication-use process and safe medication use are two important principles that contribute to the safe use of pharmacological agents in perioperative clinical practice. The medication-use process consists of procuring, prescribing, transcribing, dispensing, administering, and monitoring; however, variations in the medication-use process result from demands unique to the perioperative environment, and these variations can sometimes bypass the safety nets within the system. Understanding these variances will help perioperative practitioners recognize threats to patient safety and help ensure the patient’s well-being. Responsibilities of a safe medication-use system include assuring the public that practitioners use medications efficiently, safely, and effectively, and fully document all medications administered. AORN J 93 (January 2011) 136-142. © AORN, Inc, 2011. doi: 10.1016/j.aorn.2010.08.020 Key words: medication safety, standards for medication safety, medication-use process, safe medication use
Editor’s note: This is the first in a series of articles on perioperative pharmacology.
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he United States has the world’s most technologically advanced health care delivery system,1 which includes a highly dedicated and skilled workforce, state-of-the-art techindicates that continuing education contact hours are available for this activity. Earn the contact hours by reading this article, reviewing the purpose/goal and objectives, and completing the online Examination and Learner Evaluation at http://www.aorn.org/CE. The contact hours for this article expire January 31, 2014.
nology, and a wide range of pharmacological agents to support the care of patients. These desirable attributes have transformed health care during the past few decades, improving the health care delivery process as well as the system’s general quality.2 Furthermore, without these attributes, many of the advances in surgical care would not be possible. Almost every perioperative practitioner encounters medications in daily practice. Learning pharmacology, the science that deals with the action and use of medications, is a critical element of any perioperative practitioner’s education3 to ensure quality and safety in perioperative care. Rather than reflexive ordering or administering a medication to treat a condition, doi: 10.1016/j.aorn.2010.08.020
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FRAMEWORK FOR MEDICATION SAFETY modern pharmacotherapeutics requires an understanding of the underlying mechanism of action of the pharmacological agent, how that agent influences and is influenced by the condition being treated, and the agent’s capacity for causing beneficial as well as harmful clinical effects.3 This article is the first in a series dedicated to advancing the practitioner’s knowledge and application of pharmacological principles that promote safe perioperative care. This article examines two important principles, the medication-use process and safe medication use, that contribute to the safe use of pharmacological agents in perioperative clinical practice. As health care organizations strategically plan to reduce adverse events, there must be a thoughtful, comprehensive review of the medicationuse process and its relationship to the unique clinical demands of the perioperative setting. Results of recent research that examined perioperative medication errors suggest that, regardless of the size or ownership of the health care organization or facility, medication errors are occurring in the perioperative arena across the age continuum and result in a much higher incidence of patient harm than medication errors that occur in other clinical areas within health care facilities.4,5 In fact, in the most comprehensive review of perioperative medication errors known, researchers found that of 3,773 OR medications errors, 7.2% resulted in harm, which compares unfavorably with the general incidence of harm from medication errors reported at 1.4%.5 THE MEDICATION-USE PROCESS Interdependent processes that share a common goal build a system. Based on a national expert consensus meeting hosted by the Joint Commission in 1989, Nadzam6 described the medicationuse process as a system in which health care organizations operationalize five semisequential core processes: prescribing, transcribing, dispensing, administering, and monitoring. The system is composed of four components:
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TABLE 1. The Medication-Use Process1 Phase (step) Procuring Prescribing Transcribing
Dispensing
Administering
Monitoring
Definition The formal action of how organizations obtain products. The action of a legitimate prescriber to issue a medication order. Anything that involves or is related to the act of transcribing an order by someone other than the prescriber for order processing. Begins with a pharmacist’s assessment of a medication order and continues to the point of releasing the product for use by another health care professional. The action during which the medication product and the patient intersect. Involves evaluating the patient’s physical, emotional, or psychological response to the medication and the recording such findings.
1. Hicks RW, Becker SC, Cousins DD. MEDMARX Data Report. A Chartbook of Medication Error Findings from the Perioperative Setting from 1998-2005. Rockville, MD: USP Center for the Advancement of Patient Safety; 2006.
structure; inputs (ie, patient information, medication therapy information); throughputs (ie, care provided); and outputs (ie, effective, efficient, and safe treatment).
The United States Pharmacopeia5 built on the Joint Commission’s conceptualization and inserted an additional step, known as procurement, into the process.7 A synthesis of the steps of the medication-use process is shown in Table 1. Although the perioperative setting is a subsystem of the health care organization and has some processes that are similar to those of the rest of the organization, when it comes to examining medication use in the perioperative environment, there are vast differences. These variations throughout the medication-use process are a result of the demands present in the unique perioperative environment, the ways in which medications AORN Journal
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are used, and the people who administer them. Variations in the medication-use process sometimes can bypass the safety nets within the system, which may contribute to the occurrence of medication errors. Examples of variations to the medication-use process within the perioperative environment include provider-to-patient ratios and perioperative prescribing, transcribing, dispensing, and administering variations. PROVIDER-TO-PATIENT RATIO In perioperative care, the medication-use process takes a somewhat different form than in other clinical areas of the health care organization. For instance, the number of providers involved is different in perioperative care compared with other areas. At any given point in time, direct care of patients in nonsurgical areas often involves a single provider caring for multiple patients. This is not to say that a patient is not cared for by a team, but rather, each member of the team could interact in isolation, and the process repeats itself for all patients on the unit. This one-to-many relationship is starkly contrasted with care of a patient in the OR. Here, staff members outnumber the patient, which creates a many-to-one relationship. The complexity of this relationship requires a multidisciplinary team composed of, but not limited to, surgeons, RNs, and anesthesia professionals, and may include surgical and other technologists (eg, radiology, cardiovascular, perfusion). Furthermore, each team member interacts with medications in the medication-use process in a different manner and at different times. PERIOPERATIVE PRESCRIBING VARIATIONS Often, surgical patients have multiple prescribers (eg, primary care provider, surgeon, anesthesia professional). This presents many challenges with regard to complying with the recent addition to the Joint Commission’s National Patient Safety Goals (NPSG): completely and accurately reconciling medications across the continuum of care.8 Although it is not citing facilities for not complying with NPSG 8, the Joint Commission recog138
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HICKS—WANZER—GOECKNER nizes that medication reconciliation problems continue to put patients at risk. The Joint Commission expects health care providers to continue to address medication reconciliation within their organizations while NPSG 8 is reviewed and more data are collected.9 Specifically, in the OR, most medication orders are verbal or originate from surgeon preference cards and are not cross referenced with the “reconciled” medication list or a pharmaceutical reference. In addition, anesthesia professionals often perform anesthesia functions independently; therefore, not all medication being delivered to the patient at the head of the bed is being communicated to the surgical team. Finally, given the type of work demanded in this environment, it is not always possible for surgeons to “break scrub” to consult pharmacopeial references to guide medication ordering. Often, as a matter of convenience, it is the anesthesia professional who acts as the sole cross reference for medication information for the surgeon rather than a pharmacologist. In contrast, in other settings outside the perioperative continuum, prescribers most often write orders directly onto the medical record. In settings in which there is a high presence of health information technology, prescribers place orders directly through computer order entry systems. In addition, many nonperioperative settings have the luxury of an accurate and up-to-date medication list as well as access to reference materials. Another variance with regard to prescribing that presents a risk for medication error, is that the patient will transfer through various clinical areas (eg, same day surgery, preoperative holding area, OR, postanesthesia care unit [PACU]), where many hand offs between health care providers, changes in providers, changes in patient status, and changes in orders will occur. Often, it is during these transitions in care that a communication gap occurs in which not all information is well communicated or information is duplicated. For example, when the patient is transferred to the PACU, all orders should be discontinued and new orders written. In many situations, the patient
FRAMEWORK FOR MEDICATION SAFETY reaches the PACU well before the surgeon is able to discontinue the orders and write new orders. What if one set of orders is in the computer and the other is on paper? It is common practice that anesthesia orders are followed in the PACU and often the orders are in written form rather than electronic form. What if the surgeon also has written orders? Because the paper chart does not communicate with the electronic chart, what is to prevent duplication, multiple doses, missed doses, or adverse medication interactions? PERIOPERATIVE TRANSCRIBING VARIANCES In many nonperioperative settings, personnel (eg, unit clerks) manually process medication and other orders through the act of transcribing. This process may include completing tasks such as
updating the card-filing system (ie, a patientspecific, centralized document where medications, once ordered, are transcribed); placing medication orders into computerized systems to be verified by an RN and pharmacy personnel, an action that generally populates the computerized medication administration record; updating the medication administration record; preparing medication administration reminders (ie, pill cards); or sending forms to other departments (eg, sending a fax to the pharmacy) for additional action.
Within the perioperative environment, similar transcribing activities are often omitted given the limited number of orders and the requirement that patients must transition across several clinical areas in a relatively short amount of time. A medication administration record created in an outpatient setting is often an entirely different form than the intraoperative record used, and both may be entirely different from the forms used in the PACU. In essence, because of these differences, transcribing functions may not be present or orders may be transcribed after the medication has already been administered.
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Systems of electronic medical records are being implemented in many health care organizations. These systems eliminate the need for manual manipulation of many orders in the attempt to transition to paperless documentation. For such a system to be successful in centralizing information, careful attention is vital to ensure compatibility with the practice requirements of the perioperative team. Until such compatibility is achieved and every member of the team is able to use the system effectively, perioperative patients may end up having both an electronic chart and a paper record as mentioned previously. PERIOPERATIVE DISPENSING VARIATIONS Dispensing and the role of pharmacists vary not only among perioperative settings and the health care organization’s other settings but also may vary within perioperative services. In the outpatient setting, some patients arrive on the day of surgery and hand carry orders. Outpatient nurses may start implementing the orders without a pharmacist’s review in an effort to adhere to the surgery schedule. Likewise, the preoperative holding area is most likely void of pharmacy oversight. In free-standing surgical centers, the role of the pharmacist may be totally absent. Some health care organizations have dedicated pharmacists or satellite pharmacies available to the surgical team for dispensing medications, whereas, in other organizations, medications are dispensed from the main pharmacy. When a fully functional satellite pharmacy is available within the OR, pharmacy staff members can assist with mixing, diluting, and compounding medications to ensure compliance with the United States Pharmacopeia Chapter 797, a specific national standard that pertains to sterility of parenteral products.10 Yet, in many settings, the lack of pharmacy availability and oversight often leads to mixing, diluting, and compounding of medication by the perioperative nurse or anesthesia professional in the OR. Even storage of medications can vary greatly among facilities, given that some facilities use AORN Journal
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automated dispensing devices, whereas others use open-stock medication lockers located in the substerile corridor or in cabinets in the OR. Needing open-stock medications to be easily and rapidly accessible is a result of the time-sensitive nature of surgery; however, these practices bypass the dispensing function of pharmacy oversight and the final safety check before the medication is in the hands of a nurse, surgeon, anesthesia professional, or surgical technologist.
PERIOPERATIVE ADMINISTERING VARIATIONS The administering phase is the sharp point of the medication-use process where the medication and patient intersect. This phase effectively represents the last opportunity in which the perioperative team can intervene as a safety net for the surgical patient. At this point, perioperative nurses use professional knowledge, judgment, and skill in an effort to create a safe environment free of medication errors. It is imperative, therefore, that perioperative nurses have an in-depth understanding of pharmacology and the patient’s condition before they administer any medication in the OR. Historically, using the “five rights” of medication administration has been one such professional activity. The intent of the five rights is to ensure that the right patient receives the right dose of the right medication at the right time and by the right route. This practice is so ingrained that the five rights have become a legal standard for safe medication practice.11 These rights were at one time thought to be reflective of a fool-proof process, meaning that explicitly following the rights would prevent any error.11 However, the five rights are no longer considered to be the “end all and be all” with regard to safe medication use. Current research literature5,12,13 and court decisions14 highlight evidence and rationale that the five rights alone do not afford maximum protection against medication errors associated with medication administration. Up to three phases of the medication-use process precede medication administration, and all activities in each of the 140
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phases must be performed correctly and errorfree. If an error occurs in one or more of the preceding phases, then there is no guarantee that the error will be caught before medication administration. The Illinois Court of Appeals in its decision in Schroeder v. Northwest Community Hospital (December 12, 2006) wrote “hospitals were responsible for the negligence of nurses carrying out physicians’ orders who gave a medication that was clearly contraindicated for the patient.”14(p1) This decision inferred team responsibility for medication use as well as the need to review all steps of the process before administering any medication. In essence, this finding added two additional rights (ie, right indication, right documentation) to the current five rights. As a result, the seven rights now serve as a new dimension for safe medication use and can assist the health care team in identifying potential medication errors within the medication-use process. The unique and complex environment of the OR often requires perioperative nurses to deviate from what is considered to be routine medication administration practices in other areas of the health care organization. The following OR variances create an opportunity for medication administration errors to occur15: Surgical personnel routinely need to transfer medications from the original containers into a container system appropriate for delivery to the sterile field for subsequent administration. Perioperative standards require surgical personnel to relabel medications on and off the field; this process involves handwriting labels with a skin marker that can smear, smudge, or be washed off with blood, sodium chloride, and other fluids, which makes it difficult to read and thus introduces an opportunity for transcription errors (eg, labeling with the wrong medication, dose, concentration). Mixing, diluting, or compounding multiple medications or solutions on the sterile field is frequently time sensitive.
FRAMEWORK FOR MEDICATION SAFETY
Surgical personnel often must use complex medication-delivery systems (eg, anticoagulant compounds). Surgical personnel need to know toxic dose limits for a variety of products (eg, local anesthetics). Surgical personnel must recognize patient allergies as they relate to medication contraindications. Surgical personnel must be able to work in an environment that supports multiple verbal orders that require read-back confirmation and an environment with multiple distractions. Surgical personnel routinely perform multiple hand offs (eg, generally a minimum of two hand offs per medication) that involve a minimum of three team members (eg, from circulating nurse to scrub person to surgeon). The surgical environment often is not conducive for using bar-code technology, specifically with regard to medications used on the sterile field. For instance, the patient’s identification band may be draped and inaccessible, the medications may not appear on a medication administration record, and there may be no written order that has been verified by a pharmacist for placement on the medication administration record in the first place.
SUMMARY OF THE MEDICATION-USE PROCESS IN PERIOPERATIVE CARE Suffice it to say, the medication-use process in the perioperative setting can be significantly different than in other areas of the health care organization. Because of the variances, many of the institutional safety practices may not be applicable to the unique care demands of surgical patients. Additional burdens lie with the perioperative team to ensure that the process does not lead to harm. Understanding the medication-use process and appreciating the variances will help perioperative practitioners recognize threats to patient safety while ensuring the patient’s well-being.
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SAFE MEDICATION USE Safe medication use is another component of clinical practice and is predicated on professional responsibilities and accountabilities. Responsibilities of a safe medication-use system include assuring the public that practitioners use medications efficiently, safely, and effectively, and fully document all medications administered.16 Three ideal principles align to result in safe medication use.16,17 First, the system is patient centered, which means that the welfare of the patient is at the center of care. Second, the system is based on respect for others, which infers that collaboration occurs between team members involved in the medication-use process. Third, health care workers accept responsibility and accountability for their own actions. From the ideal principles of safe medication use stem a number of specific qualities, conditions, or characteristics that are integral to operating such a system. One such characteristic is that the system is seamless16 to ensure continuity of care, smooth transitions of care and responsibility from one provider to another, and incorporates sufficient information technology to reduce untimely delays and the perverse reliance on memory alone. Another characteristic is that safe medication use incorporates proper use of all resources and talents.16 Safe medication use includes making use of the vast experiences represented by human capital. For example, expanding the presence of pharmacists in the perioperative setting should yield similar results to those seen when pharmacists began participating in other clinical settings.18 Another characteristic of safe medication use includes organizational policies and procedures that include all medications on the health care organization’s formulary.16 Such policies and procedures facilitate compliance with federal requirements (eg, in terms of controlled substances) and accreditation requirements, and encourage the use of a comprehensive patient medication profile. Medication reconciliation facilitates an awareness of risk that is present with all medication use.17 AORN Journal
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CONCLUSION Modern perioperative care would not be possible without simultaneous advances in surgical techniques and pharmacology. Both contribute to successful outcomes for patients. It is incumbent on all perioperative professionals to be aware of two very important areas that contribute to these outcomes: the medication-use process used within the specific care area and the principles of safe medication use. Patients are placed at undo risk for a medication error if health care providers fail to fully appreciate the roles, responsibilities, strengths, weaknesses, and limitations in these two areas.
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Editor’s note: The views expressed are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of the Defense, or the United States Government.
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References Gabel J, Fitzner K. New evidence to explain rising healthcare costs. Am J Manag Care. 2003;9(Spec Issue 1):SP1-SP2. 2. Chamberlain JM, Slonim A, Joseph JG. Reducing errors and promoting safety in pediatric emergency care. Ambul Pediatr. 2004;4(1):55-63. 3. Brunwald E. Foreward. In: Golan DE, Tashjian AH, Armstrong EJ, eds. The Pathophysiologic Basis of Drug Therapy. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2008:ix. 4. Goeckner B, Gladu M, Bradley J, Garmon SC, Hicks RW. Differences in perioperative medication errors with regard to organizational characteristics. AORN J. 2006;83(2):351-368. 5. Hicks RW, Becker SC, Cousins DD. MEDMARX Data Report. A Chartbook of Medication Error Findings from the Perioperative Setting from 1998-2005. Rockville, MD: USP Center for the Advancement of Patient Safety; 2006. 6. Nadzam D. A systems approach to medication use. In: Cousins DD, ed. Medication Use: A Systems Approach to Reducing Errors. Oakbrook Terrace, IL: Joint Commission on Accreditation of Healthcare Organizations; 1998. 7. Santell JP. Medication errors: experience of the United States Pharmacopeia (USP). Jt Comm J Qual Patient Saf. 2005;31(2):114-119. 8. 2010 National Patient Safety Goals (NPSGs) Effective July 1, 2010. The Joint Commission. http://www .jointcommission.org/PatientSafety/National PatientSafetyGoals. Accessed October 18, 2010. 9. Medication reconciliation National Patient Safety Goal to be reviewed, refined. The Joint Commission.
http://www.jointcommission.org/PatientSafety/National PatientSafetyGoals/npsg8_review.htm. Accessed October 17, 2010. USP 具797典. In: Guidebook to Pharmaceutical Compounding—Sterile Preparations. Rockville, MD: US Pharmacopeia; 2010. Austin S. Seven legal tips for safe nursing practice. Nursing. 2008;38(3):34-40. Wanzer LJ, Hicks RW. Medication safety within the perioperative environment. In: Fitzpatrick JJ, Stone PW, Hinton Walker P, eds. Annual Review of Nursing Research. Vol 24. New York, NY: Springer Publishing Company; 2006:127-155. Wanzer LJ, Hicks R, Goeckner B, Cole L. A focused review: perioperative safe medication use. Perioper Nurs Clin. 2008;3(4):305-316. Medication ordered is contraindicated: court discusses nurse’s legal responsibility. Legal Eagle Eye Newsletter. 2007;15(1):1. Wanzer LJ. Perioperative initiatives for medication safety. AORN J. 2005;82(4):663-666. Lee P. Ideal principles and characteristics of a fail-safe medication use systems. Am J Health Syst Pharm. 2002;59(4):369-371. ASHP. Pharmacy-nursing shared vision for safe medication use in hospitals: executive summary session. Am J Health Syst Pharm. 2003;60(10):1046-1052. Kelly WN, Rucker TD. Compelling features of a safe medication use system. Am J Health Syst Pharm. 2006; 63(15):1461-1468.
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Rodney W. Hicks, PhD, RN, FNP-BC, FAANP, FAAN, is a nurse researcher and consultant, Lubbock, TX. Mr Hicks has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. Linda J. Wanzer, MSN, RN, CNOR, COL(Ret), is the director of the Perioperative Clinical Nurse Specialist Program and an assistant professor of nursing at the Uniformed Services University of the Health Sciences, Graduate School of Nursing, Bethesda, MD. COL Wanzer has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article. BradLee Goeckner, MSN, RN, CNOR, LCDR, NC, USN, is the division officer of SPD/CPD at NAVMEDCEN San Diego, CA. LCDR Goeckner has no declared affiliation that could be perceived as posing a potential conflict of interest in the publication of this article.
EXAMINATION CONTINUING EDUCATION PROGRAM
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Perioperative Pharmacology: A Framework for Perioperative Medication Safety
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PURPOSE/GOAL To educate perioperative nurses about the safe use of pharmacological agents in perioperative clinical practice.
OBJECTIVES 1. Define pharmacology. 2. Explain the medication-use process. 3. Describe factors that complicate the medication-use process in perioperative settings. 4. Discuss safe medication use in the perioperative area. The Examination and Learner Evaluation are printed here for your convenience. To receive continuing education credit, you must complete the Examination and Learner Evaluation online at http://www.aorn.org/CE.
QUESTIONS 1. Pharmacology is the a. available stock of medications in a pharmacy. b. science that deals with the action and use of medications. c. science that deals with drug development. d. use of medications to treat chronic disease.
2. Modern pharmacotherapeutics requires an understanding of 1. how the agent influences and is influenced by the condition being treated. 2. the agent’s capacity for causing beneficial clinical effects. 3. the agent’s capacity for causing harmful clinical effects. © AORN, Inc, 2011
4. the underlying mechanism of action of the pharmacological agent. a. 1 and 3 b. 2 and 4 c. 1, 2, and 4 d. 1, 2, 3, and 4
3. The medication-use process has been described as a system composed of the following core processes: 1. 2. 3. 4. 5. 6.
administering. dispensing. managing. monitoring. prescribing. transcribing. a. 1, 3, and 5 c. 1, 2, 4, 5, and 6
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b. 2, 4, and 6 d. 1, 2, 3, 4, 5, and 6
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4. In the medication-use process system, care provided is considered a. input. b. throughput. c. structure. d. output. 5. In the perioperative medication-use process, safety nets within the system may be bypassed because of variations in 1. perioperative administering. 2. perioperative dispensing. 3. perioperative prescribing. 4. perioperative transcribing. 5. provider-to-patient ratios. a. 4 and 5 b. 1, 2, and 3 c. 1, 2, 3, and 4 d. 1, 2, 3, 4, and 5 6. In the perioperative environment, the relationship between staff members and patients typically is a. many-to-one. b. many-to-many. c. one-to-many. d. one-to-one. 7. Factors that bypass the dispensing function of pharmacy oversight include 1. using automated dispensing devices. 2. using medication lockers located in the substerile corridor or in cabinets in the OR. 3. needing open-stock medications to be easily and rapidly accessible.
CE EXAMINATION 4. having satellite pharmacies available to the surgical team. a. 1 and 2 b. 1 and 3 c. 1, 2, and 3 d. 1, 2, 3, and 4 8. Since the Illinois Court of Appeals decision in Schroeder v. Northwest Community Hospital, the rights of medication administration have included ensuring the right 1. documentation. 2. dose. 3. indication. 4. medication. 5. patient. 6. route. 7. time. a. 1, 3, and 5 b. 2, 4, and 6 c. 2, 3, 5, 6, and 7 d. 1, 2, 3, 4, 5, 6, and 7 9. Ideal principles that need to align to result in safe medication use include that 1. health care workers must accept responsibility and accountability for their own actions. 2. the system must not vary from one area of the hospital to another. 3. the system must be based on respect for others. 4. the system must be patient centered. a. 1 and 3 b. 2 and 4 c. 1, 3, and 4 d. 1, 2, 3, and 4 10. Medication reconciliation facilitates an awareness of risk that is present with all medication use. a. true b. false
The behavioral objectives and examination for this program were prepared by Rebecca Holm, MSN, RN, CNOR, clinical editor, with consultation from Susan Bakewell, MS, RN-BC, director, Center for Perioperative Education. Ms Holm and Ms Bakewell have no declared affiliations that could be perceived as posing potential conflicts of interest in the publication of this article.
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LEARNER EVALUATION CONTINUING EDUCATION PROGRAM
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Perioperative Pharmacology: A Framework for Perioperative Medication Safety
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his evaluation is used to determine the extent to which this continuing education program met your learning needs. Rate the items as described
below.
OBJECTIVES To what extent were the following objectives of this continuing education program achieved? 1. Define pharmacology. Low 1. 2. 3. 4. 5. High 2. Explain the medication-use process. Low 1. 2. 3. 4. 5. High 3. Describe factors that complicate the medicationuse process in perioperative settings. Low 1. 2. 3. 4. 5. High 4. Discuss safe medication use in the perioperative area. Low 1. 2. 3. 4. 5. High CONTENT 5. To what extent did this article increase your knowledge of the subject matter? Low 1. 2. 3. 4. 5. High 6. To what extent were your individual objectives met? Low 1. 2. 3. 4. 5. High 7. Will you be able to use the information from this article in your work setting? 1. Yes 2. No 8. Will you change your practice as a result of reading this article? (If yes, answer question #8A. If no, answer question #8B.)
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8A. How will you change your practice? (Select all that apply) 1. I will provide education to my team regarding why change is needed. 2. I will work with management to change/ implement a policy and procedure. 3. I will plan an informational meeting with physicians to seek their input and acceptance of the need for change. 4. I will implement change and evaluate the effect of the change at regular intervals until the change is incorporated as best practice. 5. Other: ________________________________ 8B. If you will not change your practice as a result of reading this article, why? (Select all that apply) 1. The content of the article is not relevant to my practice. 2. I do not have enough time to teach others about the purpose of the needed change. 3. I do not have management support to make a change. 4. Other: ________________________________ 9. Our accrediting body requires that we verify the time you needed to complete the 1.6 continuing education contact hour (96-minute) program:
This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements. AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. AORN recognizes these activities as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentialing Center approves or endorses products mentioned in the activity. AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019. Check with your state board of nursing for acceptance of this activity for relicensure.
Event: #11001; Session: #4054 Fee: Members $8, Nonmembers $16 The deadline for this program is January 31, 2014. A score of 70% correct on the examination is required for credit. Participants receive feedback on incorrect answers. Each applicant who successfully completes this program can immediately print a certificate of completion.
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