To the Editor

If we take a few steps back from the anesthesia machine, maybe all of the way back to the staff lounge so we can get a good look at our patient care setting—and we thoroughly survey our work environment—I believe that there exists an area of gross neglect, which poses a potential risk to the general population of our post 9/11 world. A risk, I believe, which we can do a better job of decreasing. Although we all practice in settings accredited by the JCAHO, AAAHC, and AAAASF,* which have “standards” applying to the secure storage and dispensation of medications (e.g., narcotics), we would probably all recognize huge safety gaps in this category of our daily operations. Narcotics may be kept in double lock boxes; however, other drugs, such as succinylcholine, can be accessed from multiple refrigerators and anesthesia carts from the ICU to the ambulatory surgery center. During normal working hours, succinylcholine and other medications are simply not kept under lock and key. As we know, just 5 ml of succinylcholine (in the wrong hands) given intramuscularly to a 70-kg individual on the street, is lethal. I would like to see a dialogue on the merits of various improved/strengthened anesthesiology standards that would keep better tabs on the dangerous drugs used in our profession every day.

I see 2 ways in which we can improve. First, we could keep more dangerous (or potentially misused), non-narcotic medications in fewer, centralized locations that would be under some form of electronic surveillance at all times. Second, we should encourage standards that would require computer tracking chips (such as those currently used in grocery and hardware stores) to be placed inside medication vials/ampoules so that the medication could be tracked—from shipment at the factory to delivery at the bedside. These suggestions could not only decrease theft and waste, but also provide a more secure “system” within which we practice our trade. Terrorism and injury to innocent people may be just as great a threat on the smaller scale of health care institutions, as they are in the larger arenas of mass public gatherings and weapons of mass destruction.

Adam Frederick Dorin, MD, MBA
San Diego, CA

* JCAHO = Joint Commission on Accreditation of Healthcare Organizations, AAAHC = The Accreditation Association for Ambulatory Health Care, AAAASF = The American Association for Accreditation of Ambulatory Surgery Facilities.