A Current State Assessment of Anesthesiology Controlled Medication Security in Ambulatory Surgery Centers

Purpose:
The purpose of the project was to assess (1) a 5-year facility diversion history, (2) current anesthesia controlled medication security practices, (3) barriers to enforcement of closed system security and (4) determine which regulatory agency had the most influence in enforcement of drug security.

Background/Significance:
Drug diversion by anesthesia providers is an ongoing serious problem that places patient and practitioner safety in jeopardy. Research is limited, focusing primarily on physicians in hospitals. CRNAs administer a large part of the anesthetics in the more than 5,400 ambulatory surgery centers (ASCs) in the US. ASCs can not afford the same level of controlled medication monitoring support as hospitals and rely solely upon varied security methodoloat the discretion of each facility.

Methods:
An assessment was conducted through a self-report, anonymous survey distributed to administrators of ASCs in Alabama, Tennessee and Mississippi who are members of the Ambulatory Surgery Center Association (n=108). The questions elicited a 5-year facility controlled medication security history, current security methodology and attitudes toward security control. The survey included questions regarding perceived barriers to the initiation of or maintenance of closed system security, and regulatory agency influence on security enforcement. Descriptive statistics were used to summarize, organize and simplify the data through the use of frequencies and percentages

Results:
Among 41% of respondents there were 36 unresolved count discrepancies with 23% reporting a total of 25 confirmed diversions. RNs comprised 36% of diverting providers followed by anesthesiologists and then nurse anesthetists. Security questions elicited information about drug testing, drug wastage analysis, drug audits, and chain of custody methodology. Findings indicated that chain of custody security measures are not followed by the majority and monitoring methodology was limited. Thirty-nine (89%) respondents reported no security enforcement barriers and that accrediting agencies had the most influence upon security enforcement whereas state facility licensing agencies had the least.

Conclusions and Implications for Practice:
Closed system security methodology education opportunities abound. Research should be expanded to determine the national ASC diversion and security state.