Labeling solutions and medications in sterile procedural settings

Background: Confusion resulting from unlabeled solutions and medications during sterile procedures can result in serious medication errors. Case Study: During elective surgery, a seven-year-old boy was mistakenly injected with 100 times the intended dose of epinephrine. Cardiac arrest ensued, and the child died the next day. How One Hospital Met the Challenge: At Marion General Hospital (Marion, Ohio), sterile procedures are performed in the surgery department, the cardiac catheterization lab, the labor and delivery area, intensive care unit rooms, and the emergency department. MGH's surgical services management team developed a policy and protocol for medication safety that refers to labeling of medications in sterile procedural settings. Discussion: Sterile procedures often require medications or solutions to be placed in syringes or sterile basins. Facilities can eliminate the need for some solutions by using commercially available applicators or swabs, and can purchase some medications in sterile, labeled syringes. Sterile marking pens and blank sterile labels are available, as are preprinted sterile labels. The Association of periOperative Registered Nurses has helpful guidance statements and a medication safety toolkit. Conclusion: This requirement can be challenging to meet, but good resources are available.