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to patient need, so this is when you need to be extra careful.”
Reduce Error Opportunities Since even a small mistake in med- ication preparation can have serious ramifications, McIntosh says her ASC works to make the process easy. “We have designated medica- tion preparation areas with all of the tools the preparer would need, such as gloves, alcohol pads and labels,” she says. “When our staff is in that area, they are focused just on preparation and nothing else, similar to perform- ing a surgical timeout.”
A dedicated medication prepara- tion area allows for monitoring of staff performance, Patrick says. “You must know what your people are doing with injections, and correct mistakes before they cause harm. If staff are working in a dedicated area, it is easier to watch their practices than if they were behind closed doors or curtains.” At Rancho Bernardo, anesthesia
providers receive similar medication preparation support as staff, McIntosh says. “On our anesthesia carts, we have alcohol swabs, gloves and all labels available for them. We try to make prep- aration as user-friendly as possible.” Any opportunity to decrease risk is
worth exploring, says Susan Stolz, Phar- MEDium’s senior marketing manager for ASCs and alternate sites. “Safety- minded ASCs can choose to use pre- filled syringes, which may help reduce the potential for error. These ready-to- use products may be particularly helpful for emergency drugs that require dilution and LASA drugs. The unique labeling of a pre-filled syringe helps distinguish it from other medications.” McIntosh says that whenever there
is any change to Rancho Bernardo’s medication preparation process, staff are informed, and the ASC makes a special effort to draw attention to it. “When we change something on a form, we highlight that area to draw
if there is a champion within the ASC making sure that staff members receive the appropriate training and that in-ser- vices are occurring on a regular basis. “Training is not just about technique. It is helping staff make a personal connec- tion about the importance of following correct procedure every time.” At McIntosh’s ASC, a “medication
people’s attention to it. If a physician adds a medication with a different con- centration, we highlight it so anyone who looks at the narcotic log will see the new medication. We want to make sure staff do not confuse the new medi- cation with an existing narcotic or fail to see a new concentration.” An extended period of time with-
out changes is also a concern for McIntosh. “People can get used to seeing the same forms all of the time and become complacent. We change up the colors of our forms or swap around their order, which will hope- fully force staff out of ‘auto-pilot.’”
Train, Audit and Improve ASCs must make training in medication preparation a priority, Patrick says. “If there are issues concerning medication preparation that you feel need addressing, they should be high on your priority list. The CDC has an injection safety web site (
www.cdc.gov/ injectionsafety) that is a great place for education, checklists and videos.” Whitmore says that ASCA pro-
vides valuable educational resources and peer-to-peer advice. “There are a lot of people on ASCA Connect willing to share their best practices and infor- mation. ASCA and the state ASC asso- ciations provide other types of learning opportunities. ASCs should always take advantage of them.”
Stolz notes that training and edu- cation is most likely to be successful
nurse” performing monthly medica- tion safety rounds helps identify areas for improvement. “She is responsible for ordering medications, maintain- ing par levels in inventory, reviewing charts and conducting narcotic audits,” McIntosh says. “We often have a per- formance improvement study around medication, which she is involved with as well.”
Stolz advises ASCs to view accreditation surveys as learning opportunities. “Surveyors are there to help identify areas for improvement in the name of patient safety. Once you have a survey, acknowledge where you can do additional training or make process improvements to get where you need to be. Work with your accreditor to understand the different standards you must follow and how best to meet them.” She also recommends ASCs undergo
regular audits that review their medica- tion practices. “Bring in a pharmacy consultant who is an expert in medi- cation management and compliance to perform the audit. That outside opinion is going to be the most effective way to assess performance while gaining guid- ance on best practices for formulary management and operational improve- ments,” she says. Rancho Bernardo is part of Deer-
field, Illinois-based surgical solutions provider Surgical Care Affiliates (SCA), and McIntosh says she looks to her peers within the SCA network for ideas and better practices. “If we learn that another center has a more efficient process, we are always open to improving ourselves. Even little changes can make a differ- ence with patient safety.”
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