EASY ACCESS Automated medication storage systems provide security and efficiency. Note the infrared fingerprint reader to the right of the keyboard.

Not very long ago, anesthesia providers working at facilities without pharmacy departments visited a centrally located, locked medication supply room or closet before the day began to load up for the surgical schedule. While this system was simple, it wasn’t perfect. Pulling the cases took a lot of staff time, as did taking inventory later on. Return visits between cases, by the providers or the circulators they sent running for them, were sometimes necessary. “Who’s got the key?” was a common refrain. And the tendency of some providers to stock up now and worry about documentation at the end of the day often led to questions of accountability down the road.

Now, of course, we have automated medication storage and dispensing systems. Installed in a central location, the computerized cabinet technology still limits access to drugs and supplies to keep them secure. But its electronic operation can decrease the time it takes your staff to pull meds for cases, expediting workflow. Its electronic recordkeeping can accurately track your inventory, making it easy to know when to restock and re-order or even, through observing usage trends during particular schedules of cases, the amount and type of medications to preload in preparation.

In the event of a supply discrepancy, it’s easy to find out the staff member who accessed the system before the errant count. The close watch such systems keep over distribution and their automatic reconciliation can help keep your facility compliant with controlled substance regulations. Another plus: The technology can even sniff out drug diversion. Reviewing the record, you’ll be able to ask why Dr. Smith needed 8mg of Dilaudid and 100mcg of fentanyl for Mrs. Jones’s D&C, and why nothing was returned and nothing disposed as waste afterward.

Carts play a part
Ideally, every surgical facility would be equipped with an automated system, but realistically their purchase and maintenance might exceed your center’s budget, not to mention your available space. This doesn’t mean, however, that you’re limited to the locked storage closet of old. Anesthesia carts have been making strides as a mobile alternative to centralized dispensing technology, and are a practical solution if automated systems are out of your range.

EVERYTHING IN ITS PLACE Multiple-locking carts and drawers make every OR compliant with controlled substance storage regulations.

What was once essentially 3 to 5 drawers on wheels, not so different from the Craftsman tool chest in your garage, only with lockable storage, have become easily accessible and secure medication storerooms stationed in each OR. They reduce the need to hurry to the drug closet to prepare for each case, and because we can lock them and keep the keys, we own them from the time we walk into the room until the time we leave.

What’s that you say? You still have to venture out to the storage room for the specially secured narcotics (which means you first have to find the person with the keys to that vault)? Double-locking carts make controlled substances more accessible to anesthesia providers in the OR while keeping them compliant with regulators’ demands. One key unlocks the entire cart, while another unlocks a particular drawer. So now we can sign out a box of fentanyl, a box of midazolam and a vial of ketamine, keeping them in a separate drawer with their sign-out sheets (as long as we take care to double-lock the cart when it’s unattended, of course).

Some manufacturers’ carts integrate electronic functions to deliver a storage and dispensing option that’s more sophisticated than a double-lock but not as costly as an automated system. The software securing these carts enables keyless access, identifying authorized users through numerical codes, proximity keycards or fingerprint scans. Timed auto-locking prevents entry into unattended carts, and most models include actual key locks in the event a manual override is necessary.

As with the centralized systems, adding automation to carts also adds accountability. Since they do the tabulation for you, they eliminate the need for a controlled substances sign-out log. No more dosing now and reconciling later, a huge step for regulatory compliance as well as efficiency. In addition, carts that can wirelessly connect to practice management software or electronic health records systems can help to accurately capture all charges.

Advice for acquiring
As a manager making a purchasing decision on medication storage, you must certainly consider the budget. You are not going to get a Porsche on Ford Focus dollars. But since the working environment is key to a storage method’s effectiveness and efficiency, you’ll also want to consider your facility’s specific needs. How many surgical suites do you have? What’s your caseload like? What volume and types of drugs do you need to store? These questions will help you determine whether you need a centralized system or could survive with a large cart. Finally, seek the input of your anesthesia providers. A wise manager heeds the wisdom of experienced users. And make sure all your users are adequately trained on whichever solution you choose.