Anesthesia carts designed to be accessible, protected and connected help your providers work quickly and efficiently by keeping drugs, airway devices and IV supplies secure and neatly organized. Let's explore why these anesthesia mainstays are so much more than run-of-the-mill storage cabinets.

A place for everything
Stationed at the patient's head, with an anesthesia machine on one side and an anesthesia cart on the other, anesthesia providers' workspaces are a function of what's within arm's reach. As a result, providers count on anesthesia carts to be an extremely efficient part of their workflow. Most cart manufacturers allow you the flexibility to organize the drawers however you want them. Consult with your anesthesia providers to determine what items a cart should contain, how its space should be configured and where each item should be stored.

Once that's determined, it's very important to standardize every anesthesia cart in your facility (and, if anesthesia providers work at more than 1 facility, perhaps arrange for standardization across several facilities). That way, providers will be able to locate anything they need for routine procedures or emergency situations at a moment's notice, no matter which room they're in or which case they're working. In fact, our cardiac emergency crash carts are organized no differently than our standard anesthesia case carts.

A compact cart will undoubtedly occupy a smaller footprint in an equipment-cluttered OR, but a cart's storage space should be large enough to prepare anesthesia providers for an entire day's schedule of cases or at least a long enough stretch that they don't delay case starts or draw out turnover times by waiting for supplies to be delivered or leaving the room to reload.

Look for carts that are mobile and fairly lightweight, not a fixed cabinet. They need to move around the room to accommodate varying patient and equipment alignments. In larger, multi-specialty facilities, carts may also need to follow anesthesia providers to GI labs and imaging departments, where they are increasingly delivering their services.

Under lock and key, or better
The anesthesia provider's job demands immediate access to medications, but government regulations and accreditors' standards require controls to shield those medications against theft, unmonitored use and tampering. This is where carts' security mechanisms come into play.

Carts offer a number of different options and user entry procedures to keep their contents secure. Ideally, a single main lock will open all the drawers, allowing providers quick and convenient access to everything except the narcotics, which require storage in a locked bin inside the secured cart.

Each option arguably has pros and cons. Keys are the simplest solution, but as anyone who's ever asked "Who's got the key?" can attest, they're also easily misplaced. Spring-loaded mechanical locks do away with the keys, but their internal workings can fail or malfunction without warning. (Then you'll have to find the backup key.) The magnetic strips or bar codes on ID badges work fine, but badges can be stolen. And fingerprint readers are not the best choice for the OR, where anesthesia providers working at the surgical site are nearly always wearing gloves.

An automated, keyless system that integrates information technology, however, may be the most effective option. Anesthesia providers log in on a computer screen with a user ID and password. User entries are recorded, so it's evident who was in the cart and when. This is not a system that unauthorized users can exploit, since providers are not going to jeopardize medication security and their own professional reputations by disclosing their log-in information to other employees. A system that mandates quarterly password changes also provides a powerful security incentive.

The conscientious anesthesia provider will remain nearby a cart when it's unlocked and not leave an unlocked cart unattended, but some automated carts feature the ability to lock themselves down after a set amount of time. As a result, an entry system that's easy and quick for your anesthesia staff to operate is important for repeated access.

Whichever safeguard method you choose, it should never jeopardize patient safety. A huge fear among anesthesia providers — especially those who use automated carts — is that the security system isn't going to work and that they won't be able to gain access to drugs in an emergency. A backup entry or manual override method is a critical feature. While these backup access systems are often key-entry based, you might not want to rely on keys since they're not used on a regular basis and could go missing or end up away from the site where they're needed.

Instead, some automated carts feature plastic, numbered, breakaway security tags that can be pulled off by hand to gain access to the drawers. Narcotics will still be locked up internally, but every other drug an anesthesia provider needs to save a life will be available. You can keep track of the numbers on each tamper-evident tag, and in the event that emergency access is required, audit the cart's contents and replace the tag afterward.

Taking care of business
Computerized carts offer more than just security. Their ability to track what's put into and taken out of the drawers by way of bar-code scanning provides you with auditing, billing and inventory management advantages.

An automated system can document what drugs are stocked, dispensed, administered, discarded and returned, without requiring manual notation from an anesthesia provider and reporting the results more immediately than a manual audit could deliver them. This is a big time-saver for any surgical facility, and welcome assistance in complying with national standards. In their policing of medication management and occasional surveys and random inspections, government agencies and accrediting organizations are driving home the value of automation. Without it, you'll perform a lot of manual work to trace medications and show that you're properly maintaining your drug inventory.

There are similar advantages on the business side. Manual filling and billing for medications involves a page with the patient's name and a checklist of the drugs used, forwarded to the business staff or the pharmacist and, with any luck, recorded and communicated without error. Bar-code scanning and electronic recording of every drug used in the OR significantly reduces uncaptured or unidentified charges from surgery.

Connectivity between anesthesia carts and practice management software or electronic health records may not yet be a reality for all surgical facilities, but the ability to transfer information between them holds value. Keeping tabs on what's stocked and what's used can help streamline your drug purchasing process. By tracking usage volumes, costs and reported outcomes you'll generate useful data about the cost-efficiency of the medications you buy. Plus, given the current climate of drug shortages and back orders, automated medication tracking can easily determine which providers, cases and ORs need a particular product, which are using less and subsequently have enough to share, and how supply stocks can be efficiently redistributed among your anesthesia providers' carts.