Sheldon S. Sones, RPh, FASCP: Absolutely. I recommend that for those practices which use propofol (used here as the example of anesthetic drugs without reversal agents), develop a policy that reflects sections “9W” and “9V” of the AAAHC standards. As more and more facilities that formerly didn’t use propofol (i.e. some endoscopy centers) have contemplated its use, considering the growing emphasis you mention, it’s a good time to re-look at what you have.
The policy should speak to who can administer the drug (section 9V) and what to do if deeper than intended anesthesia is reached. Section 9W calls for the protocol/policy to be in place.
You may also want to address, in your policy, the focus on single patient use of vials as well as documentation. While these are not specifically mentioned in 9V and 9W, they do appear in other areas of standards, such as section “6” regarding clarity and retrievability of medical records, as well as best practice models:
Joint Commission-accredited facilities should also have a policy for this widely used agent to address standards listed under the banner of safe administration of drugs (medication management sections)
Here is a sample policy which you can use to as a basis for your own organization's policy:
Facility Name: ABC Surgery Centter
Subject: Propofol Standard of Management
Policy: The [title of individual] will manage the use of propofol*, according to best practice standards as endorsed by the anesthesia department and accrediting agencies
Procedure:
1. Administration of propofol will be under the direction of credentialed anesthesiologists or certified nurse anesthetists working under the direction of a credentialed anesthesiologist. Such credentials shall be maintained in the facility credentialing files
2. If greater than intended sedation is reached with the use of propofol, the anesthesiologist will adjust and manage the administration of propofol and provide supportive measures until the drug’s duration of effects have been completed.
3. [Title of individual] subscribes to guidelines assuring safe medication process and thus utilizes vials of propofol for single patient use only.
4] Documentation of doses of propofol administered shall be readily retrievable from the medical record.
Approved for the Governing Body__________________ MD
Date______________
*This policy will focus on propofol but would also be applicable to other sedative, hypnotic or analgesic drugs.
Note: This article comes from a recent edition of Pharm-ASC, a weekly e-mail publication by Sheldon S. Sones, RPh, FASCP, a Newington, Conn.-based consultant, pharmacist and safe medication officer serving more than 100 ASCs in the Northeast. Learn more at www.sheldonsones.com.