cases document the date, the time the drug was removed and the
time any remaining amount was returned to storage. Auditing drug
access and use must be comprehensive and ongoing; ensure accurate
and complete amounts for each agent at the start and end of each
day to ensure there are no discrepancies.
Some facilities that have manual storage models have nurses pull
controlled medications for anesthesia providers. This can facilitate
diversion by nursing staff, who may pull more than is necessary and
keep the surplus.
I often see facilities put a single staff member in charge of monitor-
ing medication supplies, placing orders and receiving and stocking
shipments. Not a wise move. Giving that responsibility to a single
staffer eliminates the oversight that's needed to ensure all medications
are secure and accounted for. It's best to institute a separation of
duties in the drug procurement process in which different staff mem-
bers are in charge of each step. If your resources aren't big enough to
allow for that safeguard, have a staff member witness and sign off on
each step of the process performed by the person in charge.
Secure the sterile field
Close knit staff understandably don't realize that they can't fully
trust their colleagues, and so they become complacent about medica-
tion security and leave controlled drugs unattended in the OR
between cases. The longer drugs remain out of secured storage loca-
tions, the more likely they are to be diverted or tampered with.
That's why meds should be prepared as close as possible to adminis-
tration.
But let's not be naïve about what really goes on during busy days of
surgery: Anesthesia providers often pull and draw up medications
well before cases begin, place syringes full of controlled substances in
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Safety
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