​Statement on Security of Medications in the Operating Room

Developed By: ASA House of Delegates/Executive Committee
Last Amended: October 17, 2018 (original approval: October 26, 2003)
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Preamble

A secure environment of care is necessary for medication safety. Medication safety includes the security of oral, sublingual, parenteral, and inhaled pharmaceutical agents used for elective and emergency patient care. A secure physical area ensures the integrity of anesthesia machines as well as other equipment and materials. Security of medications in the operating room suite is essential for patient safety.

Recommended Policies

1. Access to operating room suites must be strictly limited to authorized persons.
2. All Schedule II through V medications must be kept in locked enclosed areas when not under the direct control of an anesthesia professional.
3. Anesthesia professionals must have immediate access to drugs and equipment required for emergency patient care.  Procedures designed to prevent unauthorized access to such drugs must not impede this imperative for patient safety.
4. Anesthesia carts and anesthesia machines may remain unlocked, and non-controlled* medications may be left in or on top of unlocked anesthesia carts or anesthesia machines immediately prior to, during, and immediately following surgical cases in an operating room, so long as there are authorized operating room personnel in the OR suite.

Rationale

1. Because the operating room suite is a limited-access secure location, it is safe practice for anesthesia professionals to leave non-controlled* medications on the top of their anesthesia carts or anesthesia machines for brief periods (e.g., while going to a nearby holding area to bring a patient into the operating room).
2. At the end of anesthesia cases, when patients are particularly vulnerable, anesthesia professionals dedicate full attention to their patients. This vulnerable period extends from the time the patient emerges from anesthesia until the anesthesia professional transfers care of the patient to recovery personnel. If drugs are locked up during this vulnerable period, provider access to drugs required for emergency patient care is obstructed. Requiring anesthesia professionals to divert attention from patients in order to lock non-controlled* medications in anesthesia carts during the period between emergence from anesthesia and transport of patients out of the operating room jeopardizes patient safety. Therefore, locking non-controlled* medications at this point in the anesthetic should not be required.
3. It is necessary and safe practice for non-controlled* medications to be set up for emergency cases (e.g., obstetrics, trauma) and made secure ("locked") by a tamper-evident device that can easily be broken by authorized persons. Locks requiring knowledge of a combination or possession of a physical key jeopardize patient safety in this setting.
4. It is necessary and safe practice for emergency anesthesia drugs (e.g., dantrolene for the treatment of malignant hyperthermia) to be kept in a dedicated emergency cart or cupboard and made secure ("locked") by a tamper-evident device that can easily be broken by authorized persons. Locks requiring knowledge of a combination or possession of a physical key jeopardize patient safety, in this setting.

*The term "non-controlled" refers to medications that are not Schedule II-V.