Techs and MEDS?????

[RNOTODAY, BSN, RN]

Hi all, I have a question. I "shadowed" today at a large univ. hospital OR. This is a new field for me, I have done ER in the past. But something struck me as odd. The circulator, pours meds into a sterile cup, and the scrub tech goes back to the field with the meds, and the circulator has no more control of it, but yet is responsible for it? It strikes me as weird that an unlicensed person would even be touching meds as important as EPI, Marcain, etc. The cups were not even labeled, but even if they were, can it really be left to the techs to not mix them up? Can someone clear this up for me? Any thoughts? Opinions? I am assuming that is how it is done, not that anyone was doing anything improper, (besides the not labeling)....but.... I am just not used to giving up meds to someone who is not trained to handle them......

[tiffanycmt]

hmm i always thought if you prepared the med you gave it?????

[hondurena]

Surgical technology training is very different from what the standard "tech" nursing assistant undergoes. Surg techs complete anatomy & physiology, microbiology and pharmocology at the college level among other courses and must complete clinicals under supervision. When it comes to handling medications on a surgical field they are not "administering" they are simply passing the syringe or hemostatic agent to the surgeon or someone licensed to "administer" the medication. For example on the unit if you and your CNA are in a pts room preparing for a dressing change --- the CNA can hand you the bacitracin or whatever med you are going to put on the wound, they are not administering it but simply handing it to you. In my experience with surg techs in the OR they do label every med in the field and prior to passing it do inform the surgeon of the medication including strenght. The circulator shows the surg tech the bottle, label, and exp date.

[RNOTODAY, BSN, RN]

Surgical technology training is very different from what the standard "tech" nursing assistant undergoes. Surg techs complete anatomy & physiology, microbiology and pharmocology at the college level among other courses and must complete clinicals under supervision. When it comes to handling medications on a surgical field they are not "administering" they are simply passing the syringe or hemostatic agent to the surgeon or someone licensed to "administer" the medication. For example on the unit if you and your CNA are in a pts room preparing for a dressing change --- the CNA can hand you the bacitracin or whatever med you are going to put on the wound, they are not administering it but simply handing it to you. In my experience with surg techs in the OR they do label every med in the field and prior to passing it do inform the surgeon of the medication including strenght. The circulator shows the surg tech the bottle, label, and exp date.

Bacitracin? I would think that is a bit different from what I saw on the field today.And besides. if a cna handed you a bacitracin, you would still be administering it....It just seemed to me it was a potential for many mistakes, with pouring the meds in a cup and whatnot.I guess it just surprised me, is all.but I did not know that they had actual pharmacology coursework,,,, makes me feel a little bit better....thanks!!!!

[CarVsTree]

I guess it just surprised me, is all.but I did not know that they had actual pharmacology coursework,,,, makes me feel a little bit better....thanks!!!!

Sounds like very unsafe practice if you ask me. What about the patient in (Seattle?) that was given a cleanser (hibicleanse I think) IV instead of contrast. They were each in unlabled bowls. In our hospital it is a big JCAHO initiative for all meds in bowls to be labeled. Even for trach care the hosp has ordered new kits with labels for the peroxide, alcohol, saline, etc.

[Gompers, BSN, RN]

Who is actually administering the meds? If it's not the tech, then there isn't a problem. The only problem I see is that the meds are unlabled. THAT is unaccpetable and dangerous.

There are plenty of cases where you give meds that you did not prepare yourself. Admissions and codes are two that immediately come to mind. I know that if I've ever gotten a very sick admission, as soon as IV access is established, there are always nurses around helping me out by constituting my antibiotics and drawing them up for me so I can give them ASAP. We have standard concentrations that we always mix up, and we always double check meds, out loud, with each other. And during codes, there are meds that we have to dilute and prepare, and if you are the one that has the patient, you are too busy to do that - instead another nurse does it, labels it, checks it out loud with you, and you give it.

Like I said, if the circulator's job is to prepare meds, and someone else's job is to administer them - then as long as they're labeled correctly, why does it matter if the circulator hands them to the administrator, or if a tech is the go between?

[sunnyjohn]

As a CST I get meds poured out into sterile containers for use on the sterile field on a daily basis. As a surgical technologist we are instructed to label all medications and solutions on the field. Every little cup and syringe.

Heck, your ever supposed to label your saline and water in your basins to avoid any mixups.

The cirulator tells me exactly what she/he is pouring out, the expiration date, shows me the label and I label it accordingly on the field. I call out the name of the med or solution as I hand it to the surgeon.

In order to complete any ST program you must take a seperate class in pharmacology. About 10% of the CST exam is pharmacology based.

Of course that does not make you NEARLY as experienced as the nurse who has had advanced training in the pharmacology,drug interactions and indications, but in the cirulator/scrub role we depend on each other to be focused and attentive.

A vigilant cirulator/scrub team will catch 99.9% of operating room errors!

[RNOTODAY, BSN, RN]

Sounds like very unsafe practice if you ask me. What about the patient in (Seattle?) that was given a cleanser (hibicleanse I think) IV instead of contrast. They were each in unlabled bowls. In our hospital it is a big JCAHO initiative for all meds in bowls to be labeled. Even for trach care the hosp has ordered new kits with labels for the peroxide, alcohol, saline, etc.

THATS what I was thinking, those unlabeled cups.......plus, even if they are labeled, can you trust another person to get the right cup, without mixing them up? I mean,as far as I am concerned, the RN drawing the med, taking it from the pyxis, is responsible. I dunno.....nobody else seems to be concerned.....

[RNOTODAY, BSN, RN]

Who is actually administering the meds? If it's not the tech, then there isn't a problem. The only problem I see is that the meds are unlabled. THAT is unaccpetable and dangerous.

There are plenty of cases where you give meds that you did not prepare yourself. Admissions and codes are two that immediately come to mind. I know that if I've ever gotten a very sick admission, as soon as IV access is established, there are always nurses around helping me out by constituting my antibiotics and drawing them up for me so I can give them ASAP. We have standard concentrations that we always mix up, and we always double check meds, out loud, with each other. And during codes, there are meds that we have to dilute and prepare, and if you are the one that has the patient, you are too busy to do that - instead another nurse does it, labels it, checks it out loud with you, and you give it.

Like I said, if the circulator's job is to prepare meds, and someone else's job is to administer them - then as long as they're labeled correctly, why does it matter if the circulator hands them to the administrator, or if a tech is the go between?

Because the meds (epi was one of them) were squirted into a sterile cup, held by the tech, and the tech took it back to the field, where she drew it up from a sterile syringe when needed. There were other meds there. No labels. I understand drawing up meds in a code situation, and another person administering them. But those are qualified people, IE: another RN, an MD. From what I understood, the techs were not educated in medication administration. And since it is essentially them at the field (after they are poured into cups) who draw them up and hand them off , then that struck me as odd.

[Marie_LPN, RN, LPN, RN]

Where i work, you have to be an LPN or an RN to handle meds. This include pour onto the sterile field, or working with it on the sterile field (even though it's the surgeon administering it).

As for the unlabeled cup, i refuse to accept a med on the field till i make a label for it if it's not an emergency. If i think a med might be used, i'll make labels ahead of time, that way when a surgeon asks for something out of the oridinary, I already have my cup labeled by the time the circulator has the med ready to pour.

Unlabeled cups, basins, or syringes is EXTREMELY dangerous.

[hondurena]

Sunnyjohn, you could'nt have said it better "vigilance" is truly important-- the OR is definitely team oriented if i am scrubbed i depend on my circulator. I must trust that my team members have surgical conscious and the pts safety as a priority

[Gompers, BSN, RN]

Because the meds (epi was one of them) were squirted into a sterile cup, held by the tech, and the tech took it back to the field, where she drew it up from a sterile syringe when needed. There were other meds there. No labels. I understand drawing up meds in a code situation, and another person administering them. But those are qualified people, IE: another RN, an MD. From what I understood, the techs were not educated in medication administration. And since it is essentially them at the field (after they are poured into cups) who draw them up and hand them off , then that struck me as odd.

Didn't I say that the biggest problem was that the cups were unlabeled???

You never mentioned that they were drawing up doses later on in your original post. You just said they were transporting the meds from circulator to the field, nothing about drawing anything up.