Labelling Lidocaine

I remember reading a similar thread recently (perhaps on the OR board). I believe this is a JCAHO issue, and don't think there is much "wiggle" room.

I have heard similar JHACO ideas that would cross over to this situation.

One possible solution is not to open the bottle of lidocaine until the doctor needs it. You can hold the nonsterile outer part of the bottle while he withdraws the lidocaine with the sterile syringe and needle that that were on the delivery set. He then needs to use the med immediately. Then everyone is happy. The handwritten labels are typically not sterile. I don't know if you could sterilize them or not or would even want to go to the trouble of doing it. I know most places are probably doing what we all do of placing the lidocaine in the sterile container for the doc to draw up off the table. Common sense would think it would be ok. I guess there is potential that error could happen if something other than what was desired was placed in the sterile cup like water or normal saline. There would not be any harm but you would not acheive the therapeutic effect of analgesia. I can also think that if you wanted the lidocaine for an epesiotomy there would probably also be less time and coordination for the doc/nurse 2 person draw that I described above. That would probably just be better for repairs. We rarely do epesiotomies anymore, but if you needed to do one in an emergency then analgesia is not main priority. Safety of mom ad baby is main concern at that point. Hope this helps.

I'm not sure about for deliveries, but this is a JACHO issue for the OR. There have been numerous instances of mixing up of liquids. (ie clorahexadine being given IV). In my mind, the risks outweigh the trouble. I know though that you probably don't have multiple solutions on the delivery field.

~Jen

we just got the word recently from JCAHO that you have to label meds on anything sterile...hence the delivery table. They have even invested in STERILE PENS to do this with. I think the JCAHO folks need a bit more to do. It is obvious they have too much time on their hands......:selfbonk:

I was kind of thinking along the lines of Tx-fnp.It is used right away,but not by the person who took it out of the vial (the nurse), but by the dr. I just hate to see people messing around putting on sterile gloves, etc. when more pressing tasks are at hand. For example, making sure a stool is in the room, in case there's a shoulder dystocia. I know we keep Methergine in a locked box in the fridge in the room.. often right before what I feel is a risky delivery (multip, on pit all day, etc.), I wiil take a moment to unlock the box in case I need that med in a hurry. Things can change in an instant at a "normal" delivery. I don't want to be fooling around labelling the sole med on the table that I just poured after verifying it w/ the doc who is giving it almost instantaneously, if I am needed to do McRobert's, etc. or grab a piece of missing equipment. These measures are supposed to enhance pt. safety, but I feel like thay could detract from it in this case.

We use more of sensorcaine on our tables, mgmt has decided that we are to label the clear plastic cup by writing on a steristrip and put the sensorcaine, unopened in the cup.

Why double label something?

It is never drawn up until the last second, ST holds the bottle, MD draws it out and injects it. The med is drawn over the mayo at the foot of the bed and moved 18 inches or so to the LTCS incision.

Thank goodness they don't make us stop and label the syringe in transit. SHHHH, don't let mgmt get any ideas.

JACHO requirement. I've seen lots of talk about it on a discussion list I'm on. Everyone wants to know what other places are doing. Some places have added preprinted labels to their tables for the labeling of solutions on the field.

Don't work in OR or anything so this doesnt affect me as much but seems like a sterile pre-packed syringe of frequently used meds would come in handy. then you could open the package and place it on sterile field? They may not make anything like this at all but it seems like it would work. Next thing you know JCAHO will have us going under a hood to withdraw meds into syringe!

I haven't heard any discussion of this at my facility. Of course, I work night weekends so I may have missed something.

However, we do as may other facilities do it seems. Lidocaine is at the bedside and is not opened until ready to be used. It is either poured into the bowl to be drawn up immediately or poured directly into the syringe as the OB holds it, for immediate injection. Hard to see where there could be a mix up there.

So for the OR, are we going to have to label the bowl of saline for irrigation and lap sponges? And what about the sterile water poured into the instrument pan?

We open lidocaine as it's needed. Depending on the doctor, we'll either pour it into a sterile cup on the table or the doctor draws it up (while we hold the vial) with an empty syringe from the sterile field. I think it's a good idea, cuts down on waste (thus cutting costs).