Newly Published
Perioperative Medicine  |   September 2019
An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas
Author Notes
  • From the Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
  • Part of the work presented in this article has been presented at the American Society of Anesthesiologists Annual Meeting, Boston, Massachusetts, October 3, 2017.
    Part of the work presented in this article has been presented at the American Society of Anesthesiologists Annual Meeting, Boston, Massachusetts, October 3, 2017.×
  • Submitted for publication October 8, 2018. Accepted for publication July 17, 2019.
    Submitted for publication October 8, 2018. Accepted for publication July 17, 2019.×
  • Correspondence: Address correspondence to Dr. Shah: Department of Anesthesiology, University of Michigan, 1H247 UH, SPC 5048, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-5048. nirshah@med.umich.edu. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Education / CPD / Patient Safety / Technology / Equipment / Monitoring / Quality Improvement / Opioid
Perioperative Medicine   |   September 2019
An Automated Software Application Reduces Controlled Substance Discrepancies in Perioperative Areas
Anesthesiology Newly Published on September 6, 2019. doi:10.1097/ALN.0000000000002957
Anesthesiology Newly Published on September 6, 2019. doi:10.1097/ALN.0000000000002957
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Controlled substance diversion and tracking have received increased regulatory focus in a perioperative setting in the United States. Although an automated web-based software application for management has the potential to reduce errors, little data are available to support its use.

What This Article Tells Us That Is New:

  • In a large number of patients studied, a software application that tracks perioperative controlled substance use that is integrated into the electronic health and pharmacy records and database systems is associated with a decrease in management errors.

Background: Perioperative controlled substance diversion and tracking have received increased regulatory focus throughout the United States. The authors’ institution developed and implemented an automated web-based software application for perioperative controlled substance management. The authors hypothesized that implementation of such a system reduces errors as measured by missing controlled substance medications, missing controlled substance kits (a package of multiple controlled substance medications), and missing witness signatures during kit return.

Methods: From December 1, 2014 to March 31, 2017, the authors obtained missing controlled substance medication, controlled substance kit, and witness return signature data during the preimplementation, implementation, and study period of the controlled substance management application at a single university hospital. This before and after study was based on a QI project at the authors’ institution. The authors included all cases requiring anesthesia services. The primary outcome of this study was the rate of missing controlled substance medications. Secondary outcomes included rates for kits not returned to pharmacy and missing kit return witness signatures.

Results: There were 54,302 cases during the preimplementation period, 57,670 cases during the implementation period, and 65,911 cases during the study period. 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. There was no difference in the number of missing witness return signatures (difference 0.09 per 1,000 cases; 95% CI, −0.08 to 0.26, P = 0.350). A user survey with 206 of 485 (42%) response rate demonstrated that providers believed the new application managed controlled substances better than the previous system.

Conclusions: 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.