An operating-room OR pharmacist is a great asset to the perioperative team.
The establishment of nurse-pharmacist teams in the perioperative area can reduce the incidence of adverse drug events because the pharmacist can review orders prior to administration. OR pharmacists can have a significant effect on hospital compliance with Surgical Care Improvement Project measures.
Several regulatory compliance processes can be monitored and addressed daily by OR pharmacists.
Initiating new processes and standardizing anesthesia drug trays can decrease medication errors, improve organization of anesthesia medications, and encourage safe injection practices.
Operating-room OR pharmacists assist daily with medication dosing, selection, and dispensing; compounded sterile preparations; Surgical Care Improvement Project SCIP guideline compliance; cost-containment practices; narcotic dispensing and diversion methods; pharmaceutical waste disposal; and regulatory compliance.
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The use of nurse-pharmacist teams has been reported to prevent adverse drug events during the medication-reconciliation process upon hospital admission and discharge. As a member of the first-line multidisciplinary team, the pharmacist can relieve the nursing staff of some responsibilities by reviewing preoperative medications prior to administration for appropriate selection specifically, SCIP procedures ; drug allergies; drug-drug interactions; and weight-based, renal, or hepatic dosage adjustments.
The author of this article has noted, at her hospital, the increased frequency of surgeons employing order sets meant to cover all patients undergoing a particular procedure. Although there may be advantages to this method of prescribing, what gets left out of the equation is individualized care for each patient. This hospital has made it a priority that all preoperative antibiotic orders be reviewed by a pharmacist and entered into the electronic medication-administration record eMAR prior to administration.
Frequently, patients reporting an antibiotic allergy are prescribed alternative antibiotics that are less effective, cover a larger scope of antimicrobials, or cost more than the first-line agent. This intervention can obviate the
Reasons to marry a pharmacist to switch the initial antibiotic of choice to a more costly or less effective alternative.
SCIP is a nationally recognized
Reasons to marry a pharmacist by several organizations that have collaborated to help minimize complications associated with certain surgical procedures.
This measure involves achieving sufficient antibiotic levels in the serum and tissue to adequately destroy bacteria during the surgical incision.
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The pharmacy must dispense preoperative antibiotics promptly so that the time of surgical incision is not delayed. The requirement of a surgical time-out, which was implemented by TJC inis one of the three elements constituting the Universal Protocol.
The antibiotic-selection process outlined in SCIP-inf-2 involves choosing an antibiotic that is safe and cost-effective, has antimicrobial coverage for most intraoperative contaminants specific to the procedure, and minimizes antibiotic resistance. As with any clinical intervention, the pharmacist must document the occurrence and whether the recommendation
Reasons to marry a pharmacist accepted by the physician. SCIP-inf-3 focuses on preventing antimicrobial-resistant pathogens and decreasing the incidence of Clostridium difficile infections, which have been linked to extended administration of certain antibiotics.
PSSP consists of reviewing the profiles of patients who underwent a designated SCIP procedure the morning after surgery postoperative day 1 ; identifying SCIP postoperative antibiotic orders for the nursing staff by placing a comment that is displayed on the medication label and appears in the eMAR; and contacting the physician prior to the hour postoperative deadline in cases where SCIP-inf-3 guidelines have not been satisfied.
In conjunction with the implementation of this program, an OR pharmacist was added to the multidisciplinary SCIP team. This pharmacist attends monthly meetings to evaluate recent missed measures and determine areas for improvement. Since initiation of OR pharmacist involvement, missed SCIP-inf-3 measures have been nearly eliminated, with the few remaining occurrences involving physician documentation issues. Regulatory compliance procedures are an ongoing component within hospital systems.
Some of the more common issues OR pharmacists encounter in the perioperative area are missing beyond-use dates BUDs on multidose vials MDVs ; the use of single-dose vials SDVs as MDVs; nursing carts left unlocked while unattended; and improperly labeled medication drawn into a syringe for administration.
Many staff nurses are unfamiliar with the specific regulations surrounding medication management. Discussions about SDVs versus MDVs often reveal that most nursing staff were not trained in the difference between them or how to distinguish one from the other.
After identifying the problem, the OR pharmacist can collaborate with the nursing leadership team to develop a method that will encourage compliance with BUD labeling. This simple fix allows the OR pharmacist to monitor compliance at a glance while performing daily tasks. A more difficult challenge for the OR pharmacist is to ensure that medications drawn into a syringe by nurse anesthetists in the OR are labeled according to hospital regulatory standards.
One remedy is to design an anesthesia drug tray that can accommodate prefilled syringes of the agents most commonly used during surgery. This introduces the opportunity to adjust the current trays
Reasons to marry a pharmacist allows Reasons to marry a pharmacist OR pharmacist to create a more user-friendly tray that will standardize medication placement in every OR. The next time you're picking...
FIGURE 1A depicts a general-anesthesia drug tray with no standard format or labels indicating what medication is stocked in the drawer. A good objective for the OR pharmacist is to create a new anesthesia drug tray that can hold an array of medications that may be necessary throughout
Reasons to marry a pharmacist. The tray is designed to flow from left to right, or from anesthesia induction to recovery.
All medication bays are identified with color-specific labels in accordance with the drug-class colors recommended "Reasons to marry a pharmacist" the American Society of Anesthesiologists ASA. In conjunction with designing a new anesthesia drug tray, new processes for stocking, refilling, and outdating the trays must be developed. The responsibility of maintaining the trays lies with the OR pharmacy staff. Some hospitals use a rotation
Reasons to marry a pharmacist in which anesthesia technicians deliver fresh trays to the OR and return used trays to the OR pharmacy for replenishment.
Narcotic diversion is an ongoing concern for all healthcare professions. The accessibility and constant use of narcotics render the OR a prime setting for potential diversion activity.
The American Society of Health-System Pharmacists ASHP Guidelines on Surgery and Anesthesiology Pharmaceutical Services state that the objective of a controlled-substance system is to inhibit diversion in a functional manner that does not disrupt patient care.
This involvement alone is a deterrent to narcotics diversion. The ASHP guidelines discuss the two options for dispensing narcotics for surgery: The ASHP guidelines recommend three processes for controlled-substance documentation and waste: Refractometers are more common in OR satellites, mainly because spectrometers are more costly.
The advantages of having an OR satellite pharmacy are numerous. The success of an OR satellite pharmacy depends largely on the interdisciplinary relationship developed with other OR personnel. The number of OR pharmacists nationwide is limited in comparison with other hospital pharmacy positions, and these pharmacists must acquire knowledge of medication usage not routinely taught in pharmacy school.
Individuals who value teamwork, possess effective problem-solving skills, and are eager to learn make excellent candidates for an OR pharmacist position. Nurse-pharmacist collaboration on medication reconciliation prevents potential harm. Practical aspects of choosing an antibiotic for patients with a reported allergy to an antibiotic.
Surgical Care Improvement Project. Accessed January 25, Surgical Care Improvement Project: American Society of Anesthesiologists. Statement of the labeling of pharmaceuticals for use in anesthesiology. Accessed December 23, What are safe injection practices? American Society of Health-System Pharmacists.
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ASHP guidelines on surgery and anesthesiology pharmaceutical services. Am J Health Syst Pharm. Drug diversion in the OR: Benefits of Pharmacist Collaboration The use of nurse-pharmacist teams has been reported to prevent adverse drug events during the medication-reconciliation process upon hospital admission and discharge. Compliance With Medication Management Regulatory compliance procedures are "Reasons to marry a pharmacist" ongoing component within hospital systems. Conclusion The advantages of having an OR satellite pharmacy are numerous.
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