Skip to content

IMPLEMENTATION OF STANDARDIZED PRESCRIPTION AND LABELLING IN THE CARDIAC SURGERY OPERATING ROOM

European Statement

Patient Safety and Quality Assurance

Author(s)

Elisabetta Volpi, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Irene Benassi, Specialisation school in Hospital Pharmacy, University of Pisa;
Sara Tonazzini, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Giuseppa Lo Surdo, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Mario Cossu, Information systems and information technologies, Fondazione Toscana Gabriele Monasterio
Maurizio Mangione, Information systems and information technologies, Fondazione Toscana Gabriele Monasterio
Mattia Lorenzini, Nursing, Technical and Rehabilitation Service, Fondazione Toscana Gabriele Monasterio;
Stefania Baratta, Nursing, Technical and Rehabilitation Service, Fondazione Toscana Gabriele Monasterio;
Pierantonio Furfori, Anesthesia and Resuscitation Unit, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Paolo Del Sarto, Anesthesia and Resuscitation Unit, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio;
Stefania Biagini, Hospital Pharmacy, Ospedale del Cuore, Fondazione Toscana Gabriele Monasterio.

Why was it done?

Most preventable adverse events occur during medication use, especially with intravenous (IV) drugs requiring preparation before administration. Furthermore, for infusions, proper labelling is critical to reduce the risk of medication errors.

What was done?

Our hospital has used an electronic therapeutic record (eSTU) for over 10 years. In 2020, a multidisciplinary team of anesthesiologists, pharmacists, nurses and health IT specialists developed a dedicated module to ensure traceability of drug prescribing and administration in the operating room, focusing on cardiac surgery. At the same time, infusion syringe labelling evolved from handwritten to computerized labels, improving safety and traceability. This study aimed to assess impact of a standardized electronic prescribing and labelling system.

How was it done?

All standardized IV prescriptions issued during cardiac surgeries between 2021 and June 2025 were included in the analysis. Prescriptions were categorized by administration mode (bolus or infusion) to assess healthcare professionals’ adherence to the standardized prescribing system. A qualitative evaluation of labels applied to infusions was also performed.

What has been achieved?

The standardized prescription system was used in 5.272 procedures (4.542 adults; 730 pediatric), averaging 1.009 adult and 162 pediatric surgeries per year. A total of 93.291 prescriptions were recorded (81.861 in adults, 18 per procedure; 11.430 in pediatric cases, 16 per procedure), with a progressive increase from 18.211 prescriptions in 2021 to 20.955 in 2024 (+15.1%). These results confirm the system’s usability and effectiveness of staff training. Qualitative analysis of labelling practices initially showed syringe labels were handwritten and included limited information (e.g., drug name, concentration). With the computerized system, printed labels now contain detailed data: drug name, identifying code, dose, diluent, concentration, preparation date and time.
Our data demonstrate, for the first time, that the adoption of a standardized prescription system in cardiac surgery is an effective strategy, offering a fast, safe and user-friendly approach. Furthermore, computer-generated labelling ensures complete traceability and reduces the risk of medication errors.

What next?

Growing adoption of standardized prescription in both adult and pediatric cardiac surgery confirms its feasibility in high-complexity settings. Extending this system to other surgical areas (e.g., Gynecology, Hemodynamics, Electrophysiology) may further enhance medication safety across the hospital.

Electronic prescription protocols for personalised sterile preparations for the paediatric surgery department

Pdf

PDF Icon

European Statement

Production and Compounding

Author(s)

Isabel María Carrión Madroñal, Concepción Álvarez del Vayo Benito , Begoña Balboa Huguet , Santiago Lora Escobar , Paloma Barriga Rodríguez

Why was it done?

-Improve security, planning, and access to information for correct prescription, administration, and management.
-Guarantee the traceability of all processes.
-Improve the satisfaction of the services involved, preventing forgetfulness and therefore management of emergency calls, unjustified need for the prescribed preparations, and incorrect packaging.
-Improve communication and the work circuit from PD.

What was done?

To prepare a protocol with the processes of prescription, validation, preparation and dispensing of personalised sterile formulations in the Paediatric Surgery Department (PSD: Otorhinolaryngology, Ophthalmology and Neurosurgery) from the Pharmacy Department (PD).

How was it done?

1. Creation of a multidisciplinary team in which a circuit for the prescription, validation, preparation and dispensing of sterile preparations was agreed.
2. Analysis with the departments involved of the personalised sterile-medications prepared by PD for use in paediatric-surgical-rooms, and the most frequent doses used.
3. Bibliographic review: PubMed®, Cochrane®, Uptodate®, Stabilis® and other sources such as the Good Clinical Practices (GCP) and the book ‘Preparation of Drugs and Magistral Formulation for Ophthalmology (JM Alonso).
4. Creation of electronic prescription protocols in ATHOS-Prisma®, containing:
• help notes and preconditions for the prescription.
• information for the administration and management of waste.
• detailed brew sheet and custom label for the PD.
5. Review of the protocols created and the circuit proposed for the prescription, preparation and dispensing.
6. Start-up of the circuit: review and validation of prescriptions, preparation of sterile formulations centralised in PD through laminar flow hoods and dispensing directly to the surgical-room on the scheduled date.

What has been achieved?

Piloting began with sterile otorhinology formulations in 2021, expanding to ophthalmology and neurosurgery in 2022-2023.
– Creation of three groups of protocols that will contain those related to each specialty to facilitate location and prescription by surgeons:
*Paediatric ophthalmology:
• Mitomycin 0.2mg/ml intraoperative-solution-trabeculectomy
• Fluorouracil 5mg/0.1ml intraoperative-solution-trabeculectomy
• Intracameral-cefuroxime 2mg/0.2ml (antibiotic-prophylaxis)
*Paediatric otorhinology:
• Cidofovir 5mg/ml intralesional (laryngeal-papillomatosis)
• Bevacizumab 2.5mg/ml intralesional (laryngeal-papillomatosis)
• Mitomycin 0.5mg/ml (choanal-atresia)
*Paediatric neurosurgery:
• Interferon-alpha 3MIU/0.6ml intralesional (craniopharyngioma)
– Sixty-two preparations have been prepared and dispensed for a total of 30 children; average age of 4 years (1-10). No adverse events were reported in any patient after the administration of these sterile preparations.
– A study limitation was sample size. Circuit under development.

What next?

The protocol is applicable to any hospital with electronic-prescription and surgical-area.

A prospective observational study of medication prescribing errors in an Emergency Department.

European Statement

Patient Safety and Quality Assurance

Author(s)

Carmen Ortí Juan, Cristina Toro Blanch, Maria Àngels Gispert Ametller, Ana Perez Plasencia, Cristina Lecha Ochoa, Anna Dordà Benito, Rosa Sacrest Güell

Why was it done?

Prescribing errors (PE) are an important cause of medication-related adverse events in the Emergency Departments (ED) but limited data are available in ED with electronic prescribing and administration (ePA) systems. Knowing the frequency and types of PE can help healthcare professionals to prevent and reduce the risk of them occurring.

What was done?

To determine the rate of PE in the ED, to classify incident types and to identify critical points where measures should be implemented to improve patient safety.

How was it done?

Prospective, observational and cross-sectional study in an ED with ePA system during 6 working days (May-June 2021). The inclusion criteria were patients stayed more than 8 hours in the ED and all patients awaiting hospitalization. Prescriptions were analyzed by a multidisciplinary team made up of two pharmacists, an emergency physician and the person in charge of the hospital’s medication errors committee. PE were reported to the hospital’s patient safety-related incident notification system.

What has been achieved?

Of the 65 prescriptions revised during the study period, PE were reported in 84 cases and 15 situations with the capacity to cause errors were detected. The average age of patients was 67 ± (SD=17,9) years and each prescription had an average of 8.4 medications. The rate of PE was 1.52 errors per patient, being higher in less severe patients than monitored patients (1.09 vs 2.0 PE per patient, respectively). The most common types of EP were omission of the usual medication (60.7%), wrong dose (15.5%), wrong frequency (7.1%) and drug is not indicated (7.1%). No adverse reactions related to EP were detected. According to the Spanish consensus about Medication Reconciliation in Emergency Units, 47.1% of omissions of usual medication were drugs that should be reconciled during the first 4 hours in the ED. The results of the study and the importance of medication reconciliation are highlighted in a session in the ED.

What next?

The PE rate in the ED was 1.52 per patient and the main type was omission of the usual medication. A cross sectional study will be made in the future and compared to the current one to establish the impact of the implemented measures on the PE rate.