Integration of the Codonics Safe Label System® and the Omnicell XT® Anesthesia Workstation into Pediatric Anesthesia Practice: Utilizing Technology to Increase Medication Labeling Compliance and Decrease Medication Discrepancies While Maintaining User Acceptability.

Background: Perioperative medication errors are recognized as a source of patient morbidity and mortality. Medication management systems with built-in scanning and label-printing functions that integrate with medication-dispensing cabinets have the potential to decrease medication administration errors by improving compliance with medication labeling. Whether these management systems will also improve periodic automatic replacement (PAR) inventory control and be accepted by users is unknown. We hypothesized that implementation of the Codonics Safe Label System®, an automated labeling system (ALS), would increase compliance with labeling guidelines and improve PAR inventory control by decreasing medication discrepancies while maintaining user acceptability in the OR. Methods: We audited a cohort of anesthesia workstations and electronic anesthesia records for 2 months to compare dispensed and administered medications and establish a discrepancy baseline. We also observed a convenience sample of syringes to evaluate labeling compliance. Post-implementation of the ALS, we repeated the audit. Finally, an anonymous survey was distributed electronically to providers to assess user acceptability. Results: Pre-implementation the average daily medication discrepancy rate was 9.7%, decreasing to 6.1% post-implementation (χ2 1 = 43.9; P < .0001). Pre-implementation 330 of 696 syringes (47.4%) were either missing a label or labeling elements. After implementation, 100% of all syringes received a label with the complete required labeling information (P < .0001). All respondents agreed or strongly agreed that the system was easy to use, accurate, met their needs, printed labels quickly, improved safety and efficiency, and was recommendable. Conclusion: The ALS significantly increased the rate of best-practice-compliant medication labeling while reducing medication inventory discrepancies. The system was highly accepted by providers.

A low blood volume LC-MS/MS assay for the quantification of fentanyl and its major metabolites norfentanyl and despropionyl fentanyl in children.

Preterm and term neonates often require surgical procedures and analgesia. However, our knowledge about neonatal pharmacokinetics of fentanyl, the most commonly used drug for these procedures, and its metabolites is still incomplete. To facilitate pharmacokinetic studies of fentanyl and its metabolites in neonates and other children, we developed and validated an LC-MS/MS method based on minimally invasive, low blood volume sampling. LC-MS/MS was used for the simultaneous analysis of fentanyl, despropionyl fentanyl (DPF), and norfentanyl from dried blood samples (DBS) collected on filter paper. Positive ions were monitored using multiple reaction monitoring. Since the standard matrix for measuring fentanyl blood concentrations is plasma, the assay was developed and validated in plasma, whole blood, and then DBS. Our method was able to measure clinically relevant levels of fentanyl and its metabolites. In DBS, the lower limits of quantification were 100 pg/mL for fentanyl with a range of reliable response from 0.1 to 100 ng/mL (r(2)>0.99) and 250 pg/mL for both DPF and norfentanyl with a range of reliable response from 0.25 to 100 ng/mL (r(2)>0.99). In plasma and in DBS inter-day accuracy and precisions of fentanyl met predefined acceptance criteria and also indicated comparable assay performance in both matrices.

Use of virtual reality for epidural placement in an adolescent with ischemic priapism.

In children with chronic pain conditions, the acute pain and anxiety induced by routine procedures such as dressing changes, phlebotomy, and lumbar punctures may be amplified compared to that experienced by healthy children. However, sedatives and opiates may be contraindicated if respiratory depression is a concern. In this case report, we describe a 17-year-old male with ischemic priapism secondary to sickle cell disease in whom we used virtual reality immersion as a distraction method during epidural catheter placement. No sedation or analgesia was needed, and the patient reported no pain or distress.