Multi-modal system checks in an attempt to eliminate narcotic discrepancies

Background: Substance Abuse is very high among anesthesiologists. Recent data have shown that 32% of anesthesiologists have used drugs to “get high,” while 16% have stated they were drug dependent. Anesthesiologists have a 2.5 times higher rate of drug abuse than the average physician. Multiple factors play a role in explaining the high incidence of substance abuse among anesthesiologists. Proximity to large quantities of highly addictive drugs, relative ease at diverting small quantities of drugs, and a high stress environment all play a role. Additionally, a workplace that sensitizes reward pathways and promotes substance abuse also contributes. Methods: We tracked narcotic discrepancies for seven years, from 2013 through 2019. We received the total number of narcotic discrepancies from data through the hospital reporting system. In the span of the seven years, multiple process changes were put into place to reduce the number of narcotic discrepancies. In 2015, the Omnicell automatic drug delivery system was placed into each operating room (OR). This offered both customized access to narcotics throughout a surgical procedure and clear documentation of quantities of narcotics taken out for each patient. In 2016, pharmacy started e-mailing anesthesia providers if their narcotic documentation was not accurate. This added a second check to narcotic quantities and brought about the most dramatic decrease in discrepancies. The last process we added was a narcotic hand off tool in the electronic medical record. This tool documents narcotic quantities being handed off to another anesthesia provider during staffing changes. Results: No single process change resulted in complete resolution of all narcotic discrepancies. When the pharmacy started to give feedback on the narcotic discrepancies, the total number of discrepancies decreased dramatically by 85%. The addition of the “hand-off tool” also reduced the number by an additional 35%. Conclusion: We found when there are multiple system and personnel checks, the number of narcotic discrepancies decreased more than just one system or check in place.