Verifying Medications in PACU

[kevinjen2]

Hi everyone, my facility has patient populations that include both pediatrics and adults. We have recently had some medication errors that is related to our process and I was wondering how other facilities do things.

When a patient comes to pacu, we have an anesthesia order sheet where they fill out what medications we are allowed to give. We give these medications without being verified by pharmacy, we do not have scanners either.

How does your facility operate? When a patient arrives to pacu and needs medications quickly, how do you do it?

[azhiker96, BSN, RN]

We give the meds the patient needs. I know pharmacy reviews the orders as quickly as they can but for the good of the patient I don't wait for that to occur. We have an EMR but also the ability to pull any medication for our patients. As a critical care area I think that is vital.

I understand the hospital wanting the pharmacy check on whether the med, dose, route, etc is appropriate but when my pt has room temperature BP, stridor, severe bradycardia or any other life threatening condition I am not going to wait for a pharmacy sign off.

[HeySis, BSN, RN]

We have an electronic MAR, but we can override and get a lot of meds before the pharmacy has reviewed... but any controlled medication given to a pediatric patient has to be double checked and double signed by another RN.

[djmatte, ADN, MSN, RN, NP]

We always have override authority on specific drugs that are Pacu specific. But if there was something pressing like pain, I used to just petition the CRNA to cover it during report.

[RainMom]

Our process is similar to yours. We have hard copy order sets for adult or peds that the MDA marks. Double check allergies & give what is needed. No scanner & pyxis access to the entire formulary. What kind of errors are you seeing?

As far as peds goes, we typically check off with another nurse regarding the calculation although I don't know that it is necessarily policy. We just don't have a need to give most of our peds pts any medication so when we do, we double check it. Nearly all peds here are minor outpt procedures that we get to phase II asap for po meds. Most of those come out very good as far as pain, so only occasionally need a touch of fentanyl (mostly older children with T&As).

[MunoRN, RN]

Our anesthesiologist/surgeon clicks a box in the EMR for the PACU orderset, pharmacy review usually isn't completed until well into the patient's PACU stay, so it wouldn't be appropriate to wait until it's complete, it's a nice extra check but not something we hold treatment waiting for.

If you've had specific med errors the best way to try and prevent them in the future is to look specifically at the details of error, was the wrong dose given? wrong med?