The process of administering medications in hospital operating rooms can be time-consuming and inefficient. Unlike most nursing units across the United States – which have transitioned to automated dispensing cabinets over the past 30 years – many ORs are still using painstaking manual methods to distribute medications. In contrast, automated anesthesia medication carts are operating room workstations with sophisticated software that offers clinicians relief from the burden of medication management. While these carts are not a new concept, they have not yet been as widely adopted as other pharmacy automation. 

Anesthesiologists need rapid and simple access to medications to care for their highly vulnerable patients. In addition, the opioid epidemic and new regulatory mandates require pharmacies to develop a better chain of custody for narcotics. The move to automation in the OR has potential to increase patient safety, reduce lost patient charges, improve narcotic control and create more efficient workflows.

The manual medication distribution processes that are still practiced in countless anesthesia departments can hinder a health care organization from maximizing its potential. The typical workflow – in which a provider determines the appropriate medication, removes it from a tray or cart and then administers the medication – makes it difficult for anesthesia providers and pharmacy professionals to handle medication inventories and patient charges and oversee controlled substances. They must budget time within their workflow to visit the pharmacy, or a centralized automated dispensing cabinet, to check in and check out narcotics. Often, a nurse will need to leave the operating room to retrieve narcotics, which are then stored in fanny packs or pockets of scrubs to be used for one or multiple patients. On the pharmacy side, makeshift containers sealed with fasteners are used as narcotics boxes. The pharmacy personnel must review, refill and secure the contents of each box upon return. They also have the tedious task of manually entering the charge sheet data. It is easy to see how these processes can be prone to human error.  Non-controlled medications are often stored in trays which are refilled daily, and many ORs use a tray-per-case process. When these trays are returned to the pharmacy, personnel restock them and record the missing medications. There’s no suitable way to audit what was administered to the patient versus what remains in the tray. Patient medication charges are recorded manually even if the anesthesia medication administration is documented electronically in the medical record.