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What’s New in the Patient Safety World

September 2022

ISMP Guidelines for Safe Medication Use in Perioperative and Procedural Settings



ISMP has released its “Guidelines for Safe Medication Use in Perioperative and Procedural Settings” (ISMP 2022). As you’d expect from ISMP, it is both comprehensive and practical and covers pre-, intra-, and post-procedure phases.


A section on Patient Information includes comments on medication reconciliation but has several other very important points. It emphasizes that patients need to be characterized as opioid-naïve or opioid-tolerant. It also cautions that patient weights should be obtained on the day of the surgery or procedure and measured only in metric units (e.g., grams or kilograms). It specifically recommends avoiding the use of a stated, estimated, or historical weight.


In keeping with our many columns on opioid-induced respiratory depression, the ISMP guideline recommends use continuous electronic monitoring of both oxygenation (e.g., pulse oximetry) and adequacy of ventilation (e.g., end-tidal carbon dioxide, capnography) for patients in perioperative and procedural settings receiving one or more of the following:


Regarding medication information they focus:


Regarding communication of medication orders and information they stress that verbal orders should only be accepted if done face-to-face with providers who are onsite when ungloving would be impractical. Hearback should be utilized in all such cases.


It has multiple recommendations regarding drug labeling, packaging, nomenclature, standardization, storage, and distribution. There is a section on proven infection prevention practices when storing, preparing, and administering medications, such as avoiding use of syringes or vials intended for single use on multiple patients.


It has multiple recommendations regarding smart pump technology.


It has sections on environmental factors, workflow, staffing patterns, staff competency and education, as well as patient education.


Importantly, it stresses use of redundancies such as independent double checks and use of integrated machine-readable coding (e.g., barcode scanning, RFID) for verification of medications.


A section on quality processes and risk management emphasizes importance of a safety culture of learning and shared accountability (e.g., JUST CULTURE).







ISMP (Institute for Safe Medication Practices). Guidelines for Safe Medication Use in Perioperative and Procedural Settings. ISMP 2022







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