10 - Medication Safety in Special Contexts

Summary

In previous chapters, we have discussed medication safety in perioperative settings: for the most part, we have used literature and data from high-income countries (HICs) and have focused primarily on broad categories of the medication process (transitions of care, intraoperative, postoperative, etc.) to differentiate risks in each location. In this chapter, we turn our attention to some special contexts where medication safety has unique aspects. First, we review data from low- and middle-income countries (LMIC), as their special circumstances open them to different medication risks and significantly limit which of the recommendations we have made can be implemented. Both of the authors have traveled to a variety of LMIC, and we have been deeply impressed with the expertise, dedication, and resourcefulness of healthcare workers who often have to work under very difficult conditions with very limited resources. Information is usually accessible, in large part due to the penetration of the Internet into nearly all countries, which provides online access to current literature, books, and web-based guidelines that is not limited by borders, although it may be by economic considerations. However, in many countries, particularly in Sub-Saharan Africa, there is a dearth of trained physicians in general, and trained anesthesiologists in particular (1). Many anesthetics are administered by nurses or technicians with variable levels of training in anesthesia. Often these anesthesia providers earn poor salaries, have poor working conditions, and are not in a strong position to exercise influence on behalf of themselves or their patients. There may also be shortages of nursing staff trained to care for postoperative patients, and in some places, the burden of this care may fall heavily on families, who, of course, seldom have any relevant training.