CCI Institute for Excellence: Medication Mismanagement Issues in Anesthesia Care

Medication and controlled substance management is a core premise of anesthesia care. Even though new technological advancements have made it harder for drug abuse, drug diversion, dosing errors, labeling errors and other issues to become problems, it is still up to anesthesia providers to remain vigilant in preventing medication mismanagement. Understanding the most common issues concerning medication mismanagement is important in reversing it. Here, we will explain how common medication errors occur, in an effort to help others recognize and avoid these safety hazards.

Importance of Aggressively Addressing Medication Mismanagement

Medication mismanagement is extremely serious. Almost all accreditors consider any medication-related citation to be “high risk,” which can result in a site revisit and accreditation jeopardy. Additionally, it must be considered that addiction is a real issue in the anesthesia workplace. Factors that may explain the high incidence of drug abuse among anesthesia providers relative to other healthcare professionals is their proximity to large quantities of highly addictive drugs, the relative ease of diverting particularly small quantities of these agents for personal use and the high-stress environment in which anesthesia providers work. Given the potentially deadly nature of drugs accessible to anesthesia providers, the importance of addressing medication mismanagement cannot be underscored enough.

Controlled Substance Mismanagement Examples

Common examples of controlled substance mismanagement include the following:

Improper Documentation

Perhaps a medication is removed from the drug repository, but no indication of administration has been documented. Failing to document a drug’s administration can result in allegations of diversion, an investigation initiated by the hospital, a report to the state board of pharmacy and a report to the Drug Enforcement Administration (DEA). Even though inaccurate conclusions may be drawn, this chain of events could still result in ultimate removal of a provider’s privileges and staff membership.

Improper Drug Disposal

“Wasting” a drug without a witness is a violation of most hospital policies. The DEA requires that controlled substances be discarded in a non-retrievable manner; EPA prohibits the disposal into a city’s sanitary sewer system via a sink or toilet is considered mismanagement. Controlled substances cannot be discarded into a sharps container, either. Special receptacles with absorbent material are now approved by the DEA for disposal. The use of multi-dose vials for controlled substances should be avoided at all costs since precise measurement of the drugs remaining in the vial is problematic, along with all the other issues related to multi-dose vials. To properly dispose of drugs, ensure you have a professional wasting witness according to policy, dispose into an absorbent material, return unused, opened drugs to a pharmacy for testing and return any unopened drugs to storage.

Improper Medication Security

If a non-licensed person or unauthorized individual accesses any medication unobserved, the medications are not controlled. These incidents most often occur when medications are left on anesthesia carts. Additionally, medications must be transported securely—not in a person’s pocket.

Stay Up to Date on Latest Practices

CCI Anesthesia works diligently to ensure that our anesthesia providers are abiding by all facility-specific policies related to medication management. Each facility has its own nuances pertaining to medication management, which our providers thoroughly understand before performing their first case at that facility. Through the CCI Institute for Excellence, we keep our anesthesiologists and certified registered nurse anesthetists (CRNAs) up to date on the latest best practices and quality control initiatives announced by regulatory agencies and professional associations.

We are actively recruiting CRNAs to work in hospitals and surgery centers across the country. Whether you are interested in a full-time or part-time position, we may have the job you are looking for. View our open job opportunities today or contact us to schedule an appointment to talk with one of our recruiters. 

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