Perioperative pharmacology: blood coagulation modifiers.

Blood coagulation is the process that results in the formation of a blood clot to stop bleeding from a damaged blood vessel. Various pharmacologic agents can affect the coagulation process. The American College of Chest Physicians' evidence-based practice guidelines for perioperative management of antithrombotic therapy provide guidance for anticoagulant or antiplatelet therapy and bridge therapy. Perioperative nurses must understand the pharmacologic principles of the most common blood coagulation modifiers related to perioperative use. The perioperative nurse's responsibilities regarding administration of blood coagulation modifiers include reviewing the patient's pertinent laboratory results (eg, prothrombin time, partial thromboplastin time, international normalized ratio), recognizing the underlying conditions that require blood coagulation therapy, and documenting all pertinent information. Perioperative nurses also should participate in development of detailed storage and retrieval policies related to heparin.

Perioperative pharmacology: antibiotic administration.

Accurate and timely administration of antibiotics is a crucial element of perioperative patient care but, often, pharmacologic implications of antibiotics are overlooked or misunderstood. Preventable medication errors that involve antimicrobials occur throughout the perioperative continuum. Examples of errors associated with antimicrobial use include omitted doses, duplicate doses, incorrect doses, and antimicrobial products given to patients with preexisting allergies. Perioperative nurses can contribute to safe antibiotic administration through education and improved communication. Perioperative managers should ensure that practitioners have access to standards for antibiotic administration and accurate information and assistive technologies. Numerous resources, including measurement tools and published guidelines, are available to support adherence to surgical site infection prevention requirements and assist in ensuring effective and safe perioperative antibiotic use.

Perioperative pharmacology: pharmacotherapeutics, pharmacokinetics, and pharmacodynamics.

Results of current research into perioperative medication errors have revealed that more than half of medication errors occur during the administration phase of the medication-use process. The administration phase is the point at which the medication and the patient intersect and the medication imposes its pharmacological effect. During this phase, the only safety net between the patient and the medication is the health care provider's attention and care when administering the medication. To help mitigate these errors, perioperative nurses must understand pharmacotherapeutics: the use of medications to prevent, treat, cure, or alleviate symptoms of disease. Pharmacotherapeutics incorporates pharmacokinetics (ie, what the body does to a medication after it enters the system) and pharmacodynamics (ie, how a medication acts on the body to achieve a desired therapeutic effect).

Perioperative pharmacology: a framework for perioperative medication safety.

Learning pharmacology is a critical element of any health care practitioner's education to ensure quality and safety in perioperative care. The medication-use process and safe medication use are two important principles that contribute to the safe use of pharmacological agents in perioperative clinical practice. The medication-use process consists of procuring, prescribing, transcribing, dispensing, administering, and monitoring; however, variations in the medication-use process result from demands unique to the perioperative environment, and these variations can sometimes bypass the safety nets within the system. Understanding these variances will help perioperative practitioners recognize threats to patient safety and help ensure the patient's well-being. Responsibilities of a safe medication-use system include assuring the public that practitioners use medications efficiently, safely, and effectively, and fully document all medications administered.

Differences in perioperative medication errors with regard to organization characteristics.

RESEARCHERS CONDUCTED a descriptive, comparative, secondary analysis using a national database to investigate differences in perioperative medication error characteristics with regard to organization characteristics. PERIOPERATIVE MEDICATION ERROR records reported to the MEDMARX database between Sept 1, 1998, and Aug 31, 2003, were examined (N = 5,210), and variables were analyzed using descriptive and inferential statistics. Statistically significant differences were found for three out of four research questions. THE STUDY'S FINDINGS provide a foundation for perioperative medication error analysis and serve as a starting point for organizations to begin investigating the medication error problem in their facilities.