Substance abuse is the most serious occupational safety issue associated with the practice of anesthesiology, with an incidence as high as 1% per year of training. The Cleveland Clinic's Anesthesiology Institute approached the process from the perspective of active prevention, including specific mandatory education programs for all department personnel on a recurring basis, strengthened procedures for the detection and prevention of diversion of controlled substances, enhanced skill building for detection of impairment, and implemented a multi-faceted drug testing program, including random and "for cause" urine screens, for prevention and early detection of abused anesthetic drugs and other substances of abuse. After 18 months of preparation, a Substance Abuse Prevention Protocol was created, which has been fully implemented as of September 1, 2007.
[Show abstract][Hide abstract] ABSTRACT: We recently described a method to identify drug diversion in the operating room (OR) from automated drug dispensing carts by anesthesia care providers, based on a retrospective outlier analysis of atypical transactions. Such transactions included those occurring on patients after their exit from the OR and on patients whose drugs were not dispensed at the location where the case was performed. In this report, we demonstrate prospectively the utility of our methodology to detect diversion by unsuspected individuals.
Each month, all transactions involving scheduled drugs by anesthesia care providers are downloaded from the pharmacy database and matched to case records from the anesthesia information management system. The frequency of atypical transactions is determined for each provider, normalized by the number of days they worked in the OR. For individuals who are >2 SDs above the mean for the month for any of the screening queries, a manual examination of their drug transaction logs is performed. Anesthesia records for such providers are examined manually to help determine the likelihood that diversion is taking place, and evidence of escalating activity is considered. Actions taken depend on an assessment of the strength of the evidence that diversion has been occurring.
Two unsuspected individuals were identified prospectively as diverting drugs. Two individuals identified as abusing drugs recreationally outside the workplace showed no evidence of drug diversion through examination of the screening reports and transaction logs, and their rehabilitation treatment teams concurred that there was a very low probability of diversion. A final individual who demonstrated suspicious activity by the screening process was determined to have been careless in documentation practices, rather than diverting.
The drug diversion screening methodology previously developed is valid for the prospective detection of unsuspected individuals diverting drugs from the OR. The system also provides material useful in the evaluation of possible diversion by anesthesia providers determined to be abusing drugs outside the workplace.
Anesthesia and analgesia 07/2011; 113(1):160-4. DOI:10.1213/ANE.0b013e31821c0fce · 3.47 Impact Factor
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