Confirm medications as well as their labels

To avoid medication errors, the scrub person and the circulating nurse should concurrently verify all medications and solutions visually and verbally by reading the product name, strength, and dosage from the labels, advises the Institute for Safe Medication Practices (ISMP) in Huntingdon Valley, PA.1

If there is no scrub person, the circulating nurse should verify the medication/solution with the person performing the procedure, the institute says. Keep all original medication and solution containers in the room for reference until the procedure is concluded, ISMP suggests.

Always reinforce the five Rs of medication safety: the right patient, right medication, right dose, right time, and right route, says Sharon Giarrizzo-Wilson, RN, MS, CNOR, perioperative nursing specialist at the Center for Nursing Practice at the Association of periOperative Registered Nurses (AORN) in Denver.

"The scrub persons, once they see the medications, need to label everything: the container it’s going into, syringes that will be used to draw for delivery for surgeons, or any other transfer device the scrub person will use to transfer medications to the surgeon," she advises.

Providers may see a manufacturer label on a vial but may not read it, Giarrizzo-Wilson warns. "We need to use active communication and not assume we’re getting what we think we’re supposed to have," she says.

Surgeons should watch the circulating nurse take the syringe, withdraw the solution, and transfer it to the scrub nurses, says James A. Yates, MD, surgeon at the Plastic Surgery Center in Camp Hill, PA.

"My rule, which I instituted years ago, is that I must see the vials," he says. Yates doesn’t permit his staff to throw away the vials after the medications have been distributed to the scrub nurse.

"I say, Show me the jars,’" he notes. "Even if they have labeled them, at least I have a second backup."

Be sure to check the label for concentration of medications such as epinephrine, he emphasizes. A concentration of 1:1,000 may mistakenly be drawn up as 1:100. "1:100 can cause severe cardiac problems depending on the quantities used vs. 1:1,000, which only permits vasoconstriction or reduced blood loss," Yates says.

At shift change or relief for breaks, require the entering and exiting staff to concurrently note and verify all medications and their labels on the sterile field, ISMP advises.

As ambulatory surgery programs tackle longer and more difficult cases, they may find that OR staff need to relieved for meals, meetings, or emergency calls. Establish workplace controls "to make sure that the patient is protected," emphasizes Giarrizzo-Wilson.


  1. Institute for Safe Medication Practice. Loud wake-up call: Unlabeled containers lead to patient’s death. ISMP Medication Safety Alert! Dec. 2, 2004. Web site: