By Agatha L. Nolen, MS, DPh, FASHP

PHARMACY CAN PLAY A VALUABLE ROLE IN IMPROVING PATIENT SAFETY IN the operating room, particularly when it comes to the stocking of anesthesia trays. The following purchasing and organizational tips can help ensure the effective and safe administration of anesthesia in the OR.

Among the first things to consider is drug vial and syringe label legibility. Remember that surgical lamps are very bright, and the lighting contrast can make label information difficult to read. I suggest bringing your vials into the OR, where they will be used, to see if they are legible for the anesthesiologists. Furthermore, because some drug vials look very similar, consider altering your purchasing practices to stock vials that feature distinct packaging, hence avoiding confusion in the OR. If you must stock vials that have similar packaging, consider placing them at opposite ends of the anesthesia tray. These practices can decrease the potential for errors involving look-alike vials and syringes.

To determine the overall layout of the anesthesia trays, measure the anesthesia cart to find out how much space you have to work with. Ideally, you should designate one drawer for staging drugs and supplies, and another for the anesthesiologists to place used syringes, vials, and so on. At the end of a case, this will allow for a complete record — including lot numbers and expiration dates — of what was administered for billing and charting purposes. The anesthesiologists should not simply throw away used items as they go, because you may lose your ability to double check what was used against your records. Of course, if your facility uses a bar coded anesthesia administration system, that information will be recorded automatically, as soon as the anesthesiologist scans the vial or syringe.

It is also advisable to have a standardized tray layout across your entire institution. By making the same drugs and supplies available in all of your OR settings – from cardiac to OB – you limit the number of opportunities for confusion amongst your anesthesiologists. Of course, if you decide to alter the layout or contents of the anesthesia trays, you need to immediately communicate this change to all of your anesthesiologists to avoid any confusion at the outset of a surgery case.

Furthermore, the process of changing the layout or contents of your anesthesia trays should be a formalized one. It is far too risky to make these changes without careful planning. For example, if 10-mg vials of a particular drug are in short supply, think carefully before simply stocking 20-mg vials of that drug in your trays. The two types of vials may be nearly identical, and an inadvertent overdose could result. So conduct a FMEA (failure mode effects analysis) before instituting any changes in order to avoid such dangerous oversights. If certain drugs present too high of a risk, you might consider removing them from your anesthesia trays altogether.

Agatha L. Nolen, MS, DPh, FASHP, is the director of OPPS (Outpatient Prospective Payment System) with HCA’s corporate offices in Nashville, Tennessee, and is also working toward a PhD in public administration at Tennessee State University. She previously served as the director of pharmacy at Centennial Medical Center in Nashville, an HCA facility.