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by Christine Beck
Published on December 3, 2018

The process of administering medications in hospital operating rooms can be time-consuming and inefficient. Unlike most nursing units across the United States – which have transitioned to automated dispensing cabinets over the past 30 years – many ORs are still using painstaking manual methods to distribute medications. In contrast, automated anesthesia medication carts are operating room workstations with sophisticated software that offers clinicians relief from the burden of medication management. While these carts are not a new concept, they have not yet been as widely adopted as other pharmacy automation. 

The case for automated medical carts in the OR

Anesthesiologists need rapid and simple access to medications to care for their highly vulnerable patients. In addition, the opioid epidemic and new regulatory mandates require pharmacies to develop a better chain of custody for narcotics. The move to automation in the OR has potential to increase patient safety, reduce lost patient charges, improve narcotic control and create more efficient workflows.

Downsides of manual medication distribution 

The manual medication distribution processes that are still practiced in countless anesthesia departments can hinder a health care organization from maximizing its potential. The typical workflow – in which a provider determines the appropriate medication, removes it from a tray or cart and then administers the medication – makes it difficult for anesthesia providers and pharmacy professionals to handle medication inventories and patient charges and oversee controlled substances. They must budget time within their workflow to visit the pharmacy, or a centralized automated dispensing cabinet, to check in and check out narcotics. Often, a nurse will need to leave the operating room to retrieve narcotics, which are then stored in fanny packs or pockets of scrubs to be used for one or multiple patients. On the pharmacy side, makeshift containers sealed with fasteners are used as narcotics boxes. The pharmacy personnel must review, refill and secure the contents of each box upon return. They also have the tedious task of manually entering the charge sheet data. It is easy to see how these processes can be prone to human error. 

Non-controlled medications are often stored in trays which are refilled daily, and many ORs use a tray-per-case process. When these trays are returned to the pharmacy, personnel restock them and record the missing medications. There’s no suitable way to audit what was administered to the patient versus what remains in the tray. Patient medication charges are recorded manually even if the anesthesia medication administration is documented electronically in the medical record. 

Benefits of medication automation in the OR

Locating automated anesthesia carts in the operating room is not only convenient for the provider, but it also allows patient charges to be captured at the point-of-dispense. As the dispenses are recorded and items fall below a par level, the cart automatically generates a refill list. Barcode scanning assures that the correct medications are restocked, and the tracking of inventory and expiration dates is simplified for pharmacy personnel. Narcotics and non-narcotics are both stored in the cart and managed the same way. Additional cart space can be used to store non-medication supplies. 
The integration of automation provides a solution to many of the problems caused by manual processes. Within an automated system, anesthesia providers no longer need to make stopping at the pharmacy for narcotics boxes or removing medication from a central cabinet part of their workflow. Narcotics are secured 24 hours a day in the OR, leaving anesthesiologists to focus on the patient without the worry of leaving medications unattended. A 2017 study showed that 95 percent of the anesthesia providers in one tertiary care facility preferred automation compared to the 5 percent who preferred the manual process. Pharmacy departments have shown significant decreases in time spent managing discrepancies, reconciling controlled substances and restocking after the switch to automation.

Some automated dispensing solutions offer integration with the anesthesia record to reconcile what was dispensed against what was administered. This adds value by enabling the ability to audit and reconcile narcotics used in anesthesia. Automation aids in safety by improving documentation of the medications given to the patient. The issue of drug diversion can also be addressed with the use of these automated monitoring tools as they identify trends and gaps in the system. Narcotics theft may also be deterred with the additional control features, such as single dose narcotic dispensing, that are available on modern carts.

Automated medication carts provide an opportunity to improve care within operating rooms just as they have strengthened the patient and provider experience in nursing units. From saving time and money to increasing clinician satisfaction and patient safety, this technology can bring invaluable change to health care organizations. 

Cerner’s RxStation Automated Dispensing Cabinet can enhance the safety and efficiency of the entire closed-loop medication process. Learn more here.