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ENSURING DRUG SAFETY IN THE PACU A.D. John, M.D. Assistant Professor Anesthesia and Critical Care Medicine Johns Hopkins University School of Medicine Baltimore, Vienna Aug-2016

DRUG SAFETY IN THE PACU  Recent article by Marty Makary in BMJ argued that medical errors are the third leading cause of death  Spurred much controversy about the data and validity of methods used to make the conclusions  Key Issues: Acknowledge that ERRORS OCCUR

BACKGROUND  As a result of the IOM original study numerous government agencies have added error prevention as key goal. This includes: CDC, AHRQ, FDA, JC, ISPM  According to the CDC: Adverse Drug Reactions  Add = $3.5 Billion to healthcare cost  As population increase in age- the number of medications increase  80% Adults take at least 1 medication  30% Take 5 or more [older and sicker take more]

ACCORDING TO THE CDC ADVERSE DRUG REACTIONS  Responsible for more than 700,000 ED visits and 120,000 hospitalizations  Approximately 40% of cost preventable  As numbers of new medicines increase so does risk of adverse drug reactions

COMMON CAUSES ERROR  Technical errors  Failure to use tests  Delay in treatment  Failure to ACT on test results  Failure to take appropriate precautions  Failure to monitor appropriately  Failure to prepare a patient before a procedure  Inadequate follow up after treatment  Delay in diagnoses  Improper dose

“DO NOT USE” LIST OF ABBREVIATIONS

MEDICATION SAFETY TIPS [ISPM]  Give drugs via constant infusion rather than bolus  Drug verification  Obtain accurate patient weight in Kg  Have pharmacy premake dose of medication  Make certain medications are in appropriate metric dose  Have warning label for dangerous drugs  Segrate and sequester dangerous drugs  Give IV medications via programmable pump  Ensure antidotes, reversal agents are immediately available  Have standardize concentrations of medications

MOST COMMON ERROR  Knowledge  Cognitive

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