Archive June 2014 XV, No. 6

Anesthesia Alert: Keys to a Safe and Orderly Anesthesia Cart

20 recommendations to help ensure safe medication management.

Sheldon Sones, RPh, FASCP


best cart set up PERFECT SETUP This 'best of the best' cart was organized by Raj Mangla, MD, of Naugatuck Valley Surgical Center in Waterbury, Conn.

Our mantra is that we do what we do not for the survey, but because we know that a safe medication environment, propelled by continued vigilance, is one of the cornerstones of any facility's commitment to prioritize safety throughout the organization. If you observe "best practices" every day, survey day becomes just another day — one that requires no special preparation.

Not a week goes by in our practice without at least one of our facilities being surveyed by any of several overseers — whether it's a regulatory, licensure or accreditation review. We know that the anesthesia cart and how the provider manages drugs are among the most common concerns and areas of "survey vulnerability." More than ever before, we see a focus on how we do what we do at the anesthesia cart location.

How can you make sure survey day is just a routine day? By doing things well for the other 364 days a year. Here are 20 recommendations to help assure safe medication management within your anesthesia practice.

  1. Organize carts for easy access.
  2. Be sure to separate look-alike and sound-alike drugs in the cart.
  3. Label all pre-drawn syringes with the industry-standard required labeling, as enunciated by accrediting and CMS overseers.
  4. Be aware of drugs that require refrigeration and those that have a labeled room temperature guideline, such as rocuronium and succinylcholine. Label them with their expiration dates.
  5. Remember that current guidelines say multiple-dose vials should be dedicated to a single patient whenever possible and that they should be discarded in patient-care areas after use.
  6. Never use single-dose vials for more than 1 patient.
  7. Be sure to discard drugs appropriately and make sure discarding of controlled drugs is witnessed in "real time."
  8. No matter how tempting it might be to use it for multiple patients, use each propofol vial for one patient only.
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