Audit on fulfillment of the European and Spanish guidelines for safety at a tertiary university hospital: a comparison after 2 years
Background: 50% of medication errors in anesthesiology are due to error in the choice of the ampoule or syringe, labeling or preparation. Prevention of such errors should be a major concern in our daily practice. 
Method: We performed an audit on labeling, reutilization and usage of syringes/pumps in our department to assess the compliance of European and Spanish guidelines on medication handling. We recorded the area, presence of anesthesia residents, type of anesthesia, the medication present in the operating room (OR) during the day and amount of medication prepared vs administered. We then compared this data to the one recorded 2 years ago1 and assess the evolution of safety culture after internal promotion in our department.
Results and Discussion: We assessed 101 OR between November 14th to 28th 2016, involving 628 syringes/pumps charged. 13% of the medication wasn´t labeled (64% corresponding to propofol and the remaining to: local anesthetics 22%, antibiotics 7%, remifentanil 2,5%, ketamine, midazolam and fentanyl 1,5%), p=NS for type of anesthesia or presence of residents in the OR. 3,2% of medication (20/628) was reused between surgeries, mainly pumps containing propofol 5/20, phenylephrine 4/20 and remifentanil 3/20. On the most common dilutions used, 88% used atropine at 1mg/ml (3 other dilutions), 99% ephedrine at 5mg/ml (1 other dilution), 100% phenylephrine at 100mcg/ml and for remifentanil 57% used 20mcg/ml and 43% 50mcg/ml.
Compared to the 2014 audit we observed a decrease in unlabeled medication from 29% to 13%, with just 1 unlabeled syringe of muscle relaxant compared to 18 and none of atropine compared to 22. Reutilization decreased from 13% to 3,2%, the greatest decrease being in midazolam: 18% to 2%. The number of dilution decreased consistently, specially for phenylephrine, going from 5 dilutions to just 1.
On pharmacoeconomic we observed that 293/628 (47%) syringes/pumps were prepared and discarded without being used, mainly atropine (141/168, 84% discarded) and ephedrine (67/111, 60% discarded).
Conclusions: Although great improvements have been done to promote a safety culture we still a long way to go; however, we can remark that even a simple intervention, like promoting safety during our weekly meetings has had a great impact. With the pharmacoeconomic data, the next step will be to promote preloaded syringes, for safety and costs reduction.
References: Kollmann et al. Should we improve our safety practice? EJA 2004;31,e-sup:256