1. Giacomelli, Barbara PharmD, MBA, FASHP


Explore the merits of this concept for improved medication management.


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Effectively monitoring and controlling medications and supplies during surgical procedures can be a challenge for hospitals. The pharmacy needs to maintain medication accountability, control, safety and regulatory compliance, while ensuring anesthesiologists have all their medications readily available. It's a juggling act, but it can be better managed with the right solution in place.


At Shore Memorial Hospital, a 296-bed community hospital in southern New Jersey, pharmacy leaders made the decision to beta test a new automated anesthesia cart. They didn't expect that the anesthesiology team would ask for more in the first week, but that's exactly what happened.


A popular choice

Shore Memorial has nine surgical and two endoscopy suites, and a staff of 20 anesthesiologists and certified registered nurse anesthetists (CRNAs). For the beta, one cart was placed in an OR and the other was designated for use in the endoscopy suite. The cart is mobile, so it allows anesthesia to effectively and efficiently move medications in a controlled manner to multiple areas in the hospital when needed. Shore Memorial is now planning to implement automated anesthesia carts in all OR suites, C-section rooms, and the other endoscopy suite based on successful implementation and positive results.


For many years, Shore Memorial used a completely manual process for medication management during surgical procedures. Then the hospital began using traditional medication dispensing cabinets in anesthesia areas. While the cabinets are a major improvement from the manual process, the workflow isn't specifically designed to match the workflow of the anesthesia provider. (The pharmacy would prepare kits of commonly used medications that would be stored in a central main cabinet and tower. The anesthesia providers would make separate trips to the cabinet after each case to prepare for the next. For narcotics, each anesthesia provider had an assigned lockbox stored in one of the cabinets. The narcotics were returned to the pharmacy at the end of the day for reconciliation.)


After working with the medication dispensing cabinets in the OR for a few years, the decision to use automated anesthesia carts was easy. Our overall goal was to adopt a solution that would allow our anesthesia providers to work faster, smarter, and safer, while meeting all of the medication management needs of pharmacy. Some key considerations in our decision to move forward with automation in the OR included: workflow designed to match how an anesthesiologist works; adequate storage space for all of the medications, narcotics, and supplies; unhindered access to medications during surgical procedures; accurate monitoring and tracking of usage; narcotic tracking to ensure accountability and minimize diversion; accurate charge capture; and waste management.


Once we added the two anesthesia carts, both anesthesiology and pharmacy recognized the positive impact of having automation specifically designed for anesthesia areas. The workflow of the cart vs the cabinet made the carts extremely popular-so popular that we had to put the anesthesiologists and CRNAs on a rotation to ensure everyone had a turn using the anesthesia cart within a given week.


Anesthesia providers require quick and easy access to drugs in any situation. When they started using the new system, they found it fast and simple to use; once they unlock the cart, it stays unlocked until they relock it, ensuring access to supplies and emergency medications. For added security when the cart is unlocked, staff use locking pockets in the top drawers for controlled substances and high-alert drugs.


To access medications, the anesthesia provider simply opens a drawer and touches the screen to dispense what they need. When the drawer is open, the user sees a virtual pocket display, which is a visual guide of all the medications located within each drawer. They just touch the medication name on the screen, and the system guides them to the correct pocket to remove the medication. This reduces the risk of error and eliminates the need to type or search.


The returning and wasting process requires only a few quick touches on the screen. All actions are documented electronically, which reduces paperwork.


More control, less paperwork

For the pharmacy, the automated anesthesia carts offer more control over the medications dispensed during surgical procedures. We have improved visibility into exactly what's being dispensed, when, and by whom.


The anesthesia carts have allowed us to streamline the workflow of our pharmacists and technicians, thereby reducing their workload. The system automatically bills the patient upon dispense, resulting in less paperwork for the pharmacy team. We also have a clear view of inventory levels, which has enabled us to make the restocking process more efficient. Additionally, documentation is much easier to manage because everything is electronic.


If you're using a manual system or traditional medication cabinets to dispense medications in your surgical areas, you may want to consider streamlining your processes by investing in automated anesthesia carts in your anesthesia areas.