diprivan for c sections

[jdpete]

Just a question out there to see who is using diprivan for stat c sections and who all still use Pentothal and what experiences these have had for you---

[jwk]

STP is a Class IV controlled substance. JCAHO takes a dim view of leaving controlled meds "out" on a cart if they are unattended.

Actually, we do this routinely for our 5 obstetrical OR's, and none of the JCAHO inspectors over the years has objected. Our rationale is that the significant risks of not having the drug immediately available for a truly emergent C-Section more than outweigh the minimal risks of leaving the drug out in a secured OR environment. The drugs are checked multiple times each day, and there has never been an issue of diversion or myteriously missing pentothal syringes.

[Just a CRNA]

Actually, we do this routinely for our 5 obstetrical OR's, and none of the JCAHO inspectors over the years has objected. Our rationale is that the significant risks of not having the drug immediately available for a truly emergent C-Section more than outweigh the minimal risks of leaving the drug out in a secured OR environment. The drugs are checked multiple times each day, and there has never been an issue of diversion or myteriously missing pentothal syringes.

I agree with the philosophy of having drugs readily available for emergent OB use. However, it's not our call, nor is it open to interpretation. The DEA and the JCAHO have some rather specific verbiage regarding the storage and security of all drugs, especially scheduled drugs.

Here is what the DEA has to say about security of controlled substances. By the way, I was incorrect earlier; STP is a Class III scheduled drug.

Security

DEA registrants are required by regulation to maintain certain security for the storage and distribution of controlled substances. Manufacturers and distributors of Schedule I and II substances must store controlled substances in specially constructed vaults or highly rated safes, and maintain electronic security for all storage areas. Lesser physical security requirements apply to retail level registrants such as hospitals and pharmacies. All registrants are required to make every effort to ensure that controlled substances in their possession are not diverted into the illicit market. This requires operational as well as physical security. For example, registrants are responsible for ensuring that controlled substances are distributed only to other registrants that are authorized to receive them, or to legitimate patients and consumers.

And now, from the JCAHO website:

Q: How does Joint Commission define "secure" in relation to medication stored in the pharmacy, patient units, operating rooms, and crash carts.

A: Stock medications stored in the Pharmacy and in patient care areas must be either locked or under constant surveillance. The same holds true for the operating room including anesthesia carts - when an anesthesia cart is unattended and not under constant surveillance, it must be locked or stored in a locked room. The same requirement applies to floor medication carts and crash carts and any prepackaged surgical or treatment packs that may contain medication.

My experience with JCAHO inspectors is that they tend to overemphasize their own rules and regs. They also tend to decompensate when they see unattended meds drawn up and ready to use. If you've had no problem with them in the past, you are fortunate. Personally, I wouldn't care to be the one to explain it to them, once they actually notice the practice. Finally, the DEA is the ultimate arbiter in this arena, and if controlled substances turn up missing, those are the guys I'd really rather not have to speak with. The fact that there has been no problem in the past doesn't mean there won't be any in the future. As much as I dislike compliance in some areas of administrative meddling, this is one area where it might be best to suck it up and follow the rules.