limit the amount of controlled substances circulating through your
facility.
First, keep automated dispensing cabinets in a secure area with limit-
ed foot traffic. Also try to ensure the cabinets are located as close as
possible to the ORs or within each room, so anesthesia providers and
staff members aren't tempted to pull medications for more than one
case, a practice that increases the amount of time medications are
unsecure and available for diversion.
To safeguard and protect against diversion, minimize the amount of
leftover medication that needs wasting — here's where prefilled
syringes can again prove beneficial — and eliminate leftover amounts
as soon as possible after cases end. It's tempting — and often more
practical — to hold onto leftover amounts of controlled substances
until a witness is available to verify that proper wasting takes place.
But the significant amount of time that could pass before a witness
becomes available could provide staff members with unmonitored
access to the leftover medications and additional opportunities to
divert the substances.
You must have a process in place that ensures your surgical team
is accountable for properly wasting leftover amounts of controlled
substances. Make sure excess amounts are wasted as soon as prac-
tically possible after cases end. The wasting of controlled sub-
stances by one member of the surgical team should be witnessed
by a second team member. Both staff members involved should
sign off on the amount of drug that was wasted.
Don't underestimate what providers who are battling addiction
will do to get their next fix. Drug diverters have been known to look
for trace amounts of medications in syringes or vials tossed into
conventional disposal containers. Controlled substance waste recep-
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