title: Medication Safety in the Operating Room: A Survey of Preparation Methods and Drug Concentration Consistencies in Children's Hospitals in the United States.
abstract: BACKGROUND
  Medication errors in the perioperative environment are an important source of iatrogenic harm to patients. In 2010 the Anesthesia Patient Safety Foundation (APSF) initiated an effort to reduce medication errors in the operating room environment. One of the components of this effort was designed to minimize error opportunities for the anesthesia provider by having the hospital pharmacy supply premixed solutions from in-house pharmacies or outside pharmaceutical companies.
  
  
  METHODS
  In a convenience sample of representatives of 34 children's hospitals across all geographic regions of the United States, the current state of the APSF medication safety paradigm was assessed. A telephone questionnaire study was conducted from June 2012 through August 2012 to determine each center's practices in providing, packaging, and administering standard anesthesia-related medications.
  
  
  RESULTS
  All 34 institutions required at least one anesthetic drug to be prepared by the anesthesia provider in the operating room. Vasopressors were the most common class of drugs to be supplied as prefilled syringes by a hospital pharmacy or pharmaceutical company. For example, 27 of the 34 hospitals surveyed supply epinephrine in a prefilled syringe at a concentration of 0.1 mg/mL (1:10,000 solution), commonly used in cardiac arrest scenarios. Several different anesthetic medications were supplied in different concentrations both between institutions and often within the same institution. None of the surveyed children's hospitals were using bar-code medication administration technology.
  
  
  CONCLUSIONS
  Some children's hospitals use standardized medication concentrations, and pharmacy-prepared syringes of anesthetic medications; however, the majority of anesthetic medications were still prepared by the anesthesia provider at the anesthetizing location.
authors.affiliation: Stony Brook University School of Medicine, Stony Brook, New York, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Shaw
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Litman