In my travels to ambulatory surgery centers throughout the country, I regularly see labeling and storage situations that could result in everything from minor mishaps to major catastrophes. Take a look at these photos I shot and see if you can figure out what's wrong with each. Hopefully, they'll serve as reminders to help prevent any similar occurrences at your facility.
1. ALL MIXED UP How much lidocaine is in this syringe? How much Marcaine? How much Wydase? It's impossible to tell. And whom would you ask? Whoever prepared the solution didn't bother to mark it with his initials, nor with the date and time it was prepared.
Those are the strengths of the medications you see, not the amounts of each. Careless preparation like this goes against just about every set of regulatory guidelines you can imagine, and it's been the root cause of many errors over many years.
2. SMALL PROBLEM These containers of BSS solution (an eye wash) have had epinephrine (a dilation agent) added, but it would be easy to miss that fact, because the added labels are small and are applied to the backs of the containers instead of the fronts.
Anyone holding the mixture should immediately see what was added, along with the date and time it was added, and the initials of who added it. (Unknowingly adding additional epinephrine could cause excessive dilation, or excessive duration of dilation.)
The date and time are key, because when admixing occurs outside of a laminar hood, as was the case here, it should be done no more than 1 hour from preparation to administration. Also, although the caps are reapplied, standard foil-wrapped-type labels are recommended.
3. IN AND OUT Succinylcholine and Rocuronium are to be refrigerated, but once removed, they can be stored at room temperature for specific periods of time (14 days for Succinylcholine; 60 days for unopened Rocuronium, 28 days for opened Rocuronium). What you can't do is open them, use them, put them back in the fridge, take them out, use them again, etc. Here, the vials were opened, never dated, and appear to have been moving back and forth between refrigeration and room temperature.
Once they're removed from refrigeration, they should be clearly marked with either the manufacturer's expiration date, or the appropriate date based on when they were removed, whichever comes first. They shouldn't be re-refrigerated.