The first study to measure the incidence of medication errors and adverse drug events during the perioperative period has found that some sort of mistake or adverse event occurred in every second operation and in 5% of observed drug administrations.
The study of more than 275 operations at Massachusetts General Hospital (MGH), which will appear in Anesthesiology, also found that one-third of the errors resulted in adverse drug events or harm to patients. The report was published online to coincide with a presentation at the Anesthesiology 2015 annual meeting.
“We found that just over 1 in 20 perioperative medication administrations resulted in a medication error or an adverse drug event,” says Karen C. Nanji, MD, MPH, lead author of the report, anesthesiologist in the MGH Department of Anesthesia, Critical Care and Pain Medicine, and assistant professor of anesthesia at Harvard Medical School, both in Boston.
The most frequently observed errors were mistakes in labeling, incorrect dosage, neglect in treating a problem indicated by the patient’s vital signs, and documentation errors. Of all the observed adverse drug events and the medication errors that could have resulted in patient harm, four of which were intercepted by OR staff before affecting the patient, 30% were considered significant, 69% were serious, and less than 2% were life-threatening. The overall medication error rate of about 5% was the same among anesthesiologists, nurse anesthetists, and residents.
Other news presented at the annual meeting included:
• Amount of anesthetic required for general anesthesia during surgery varies widely from patient to patient.
Some patients might be able to receive a lower dose than typically administered, suggests a study.
“Providing general anesthesia is a delicate balance, ensuring the patient receives enough, but not more than needed,” said Ana Ferreira, MD, lead author of the study and a medical researcher in the Anesthesiology Department at Centro Hospitalar do Porto, Portugal. “Our research shows that there is no way to predict how much a patient will need.”
Researchers determined that the amount of propofol required to produce unconsciousness varied widely between patients and was independent of age, gender, weight, or height. Close monitoring of the neurological signs and brainwaves was used to determine when the correct dosage was achieved. Patients were given propofol in a constant slow rate of infusion, which enabled researchers to continuously monitor patient response and precisely determine when loss of consciousness occurred, as well as identify the exact amount of propofol required.
• Pediatric patients are prescribed more opioids than needed for pain after surgery.
Research suggests that pediatric patients having moderate to severe pain might be prescribed more opioids than necessary following surgery. A study found nearly 60% of opioids dispensed to pediatric patients following surgery remained unused, which could lead to the unused medication being abused by adolescents in the household.
Most parents (82%) were given no instruction about what to do or how to properly discard leftover medication, which resulted in only 6% of patients’ parents disposing of opioids at the conclusion of therapy. Forty-six percent of patients had adolescent siblings, age 12 or older, who could be at risk for misusing the leftover prescription opioids.
• Maintaining blood pressure levels measured before entering OR might improve outcomes.
When a patient arrives in the OR, one of the first things a physician will do is to take his or her blood pressure. However, a new study found blood pressure taken before the patient enters the OR might produce more accurate measurements and should be used to determine baseline blood pressure.
“We found that blood pressure measured in the OR was significantly higher than readings taken during pre-surgical testing before the day of surgery or in the holding area on the day of surgery,” said John L. Ard Jr., MD, clinical associate professor, Department of Anesthesiology, Perioperative Care, and Pain Medicine at NYU School of Medicine and physician at NYC Langone Medical Center, both in New York City. “The OR environment seems to provoke anxiety in some patients that may not be present in other areas prior to surgery. This research could help physicians make better decisions regarding blood pressure management in the OR, which could lead to fewer perioperative complications such as stroke or heart attack.”
• Surgical patients should stay on cholesterol medications to reduce risk of death.
Patients who stop taking cholesterol medications before surgery are following outdated recommendations and significantly increasing their risk of death if they don’t resume the medications within two days after surgery, according to a study of more than 300,000 patients.
A 2002 clinical advisory recommended temporarily discontinuing statins for surgery, which is still reflected in the drug package insert. However, in 2007 the American College of Cardiology and American Heart Association recommended uninterrupted use of statins around the time of surgery and noted they reduce inflammation and promote blood flow. The new study suggests that these recommendations haven’t been fully heeded.