As healthcare professionals, we are under increasing scrutiny of medication handling, particularly in light of the opioid epidemic in the United States. In response, many hospitals and providers are undergoing efforts to make changes to their protocol, decrease errors in management and implement increased accountability mechanisms in order to decrease the risk of controlled substance diversion.
In response, the University of Michigan’s Department of Anesthesiology decided to implement an automated controlled substance management application. “An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas,” published in a recent issue of Anesthesiology, recorded the observations from this single-center implementation. The results reveal a hopeful trajectory for our industry, concluding:
“A software application that tracks perioperative controlled substance kits with deep integration into the electronic health record and pharmacy systems is associated with a decrease in management errors.”[i]
The Site of the Study
The University of Michigan’s Department of Anesthesiology is a tertiary care center with approximately 450 anesthesia providers and 30 pharmacy staff. Annually, they conduct 85,000 procedures per year and administer “more than one million doses of controlled substances annually across six geographically distinct facilities (adult and pediatric inpatient facilities and several ambulatory surgery centers) and more than 100 anesthetizing locations.”[ii]
Over a more than two-year period (from December 1, 2014 to March 31, 2017), the authors of this study “obtained missing controlled substance medication, controlled substance kit, and witness return signature data during the pre-implementation, implementation, and study period of the controlled substance management application.”[iii] They collected data from 54,302 cases during pre-implementation, 57,670 cases during implementation and 65,911 cases during the study period.
Most significantly, after the software was implemented on site, there was a decrease in the number of kit return errors and missing medications:
“The number of missing controlled substance medication (difference 0.7 per 1,000 cases; 95% CI, 0.38–1.02; P < 0.001) and kit return errors (difference 0.45 per 1,000 cases; 95% CI, 0.24–0.66, P < 0.001) declined after implementation of the application.”[iv] [emphasis ours]
Additionally, a user (provider) survey, with a 42% response rate, showed that providers found that the new automated software “managed controlled substances better than the previous system.”[v] [emphasis ours]
Of course, the cost of implementation, including technical infrastructure, is always a key consideration. The study reports that the overall implementation cost was approximately $500,000, with ongoing maintenance and support approximately $50,000 per year (across 100+ anesthetizing sites).[vi]
And while the results from this study have promising implications, today — beyond this single site study — little data are available to support the use of automated, web-based software applications for the management of controlled substances. In order to validate the findings, additional similar studies are needed in the future as our industry moves toward a more robust management of controlled substances within our care.
At all of Allied Anesthesiology’s institutions and surgery centers, we are extremely vigilant about narcotic accounting and integration, checking and balancing inventory counts to usage. As a company, we enforce drug testing when appropriate to ensure that our patients stay safe, doing everything possible to prevent these types of events from occurring.