At Cedars-Sinai Medical Center, there are over 5,000 controlled substance administrations in the OR setting each month. Prior to the implementation of system interoperability between the EHR and the ADC, the Pharmacy department employed a full-time auditing technician whose sole task was to ensure controlled substance accountability by manual reconciliation of anesthesia dispenses against administrations. The technician would run a retrospective ADC report and perform individual chart audits to identify discrepancies. If discrepancies were identified, the technician would email the provider to further investigate the issue.
This time-consuming and inefficient process made it clear that a new process was needed, one which would 1) alert providers to any discrepancies in real-time, before they completed a case and 2) assist the pharmacy staff in reconciling all dispenses in an efficient manner.
Through multidisciplinary collaboration between the Anesthesia, Information Systems, and Pharmacy teams, the Anesthesia Reconciliation Report was developed. The report alerts anesthesia providers of controlled substance discrepancies via a best practice advisory that occurs when they attempt to close their anesthesia encounter. The advisory provides an opportunity to reconcile dispenses in real time rather than waiting for a notification from pharmacy staff. The report can also be run on demand, allowing pharmacy staff to follow-up on outstanding discrepancies not resolved by the provider.
Overall, the report has allowed the organization to reconcile all of its anesthesia dispenses in an automated fashion and reduce the number of discrepancies identified after an anesthesia encounter has been closed. The auditing technician has been able to re-focus time previously spent on manual reconciliation on other high-risk processes.