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Changing the process for administering drugs and fluids during surgery could improve anesthesia care

Providing anesthetized patients with intravenous drugs and fluids during surgery is a complex process. Syringes must be prepared individually, and several doses of up to 20 different drugs may be administered intravenously during a single case. Furthermore, resuscitation drugs (for example, ephedrine or atropine) may be needed in the event of intraoperative emergencies.

Unfortunately, current processes for administering intravenous drugs and fluids in the operating room are inefficient and may predispose to medical error. A reengineering approach to these processes could improve anesthesia care, according to a study supported in part by the Agency for Healthcare Research and Quality (HS11375 and HS11521).

Researchers from the University of California, San Diego (UCSD), and the Veterans Medical Research Foundation had an operating room observer categorize 20 anesthesia providers' activities during 35 surgeries into 66 drug/fluid tasks to identify errors and inefficiencies. The observer studied both initial operating room set up at the beginning of a typical work day and cardiac and noncardiac general anesthesia cases. Drug/fluid tasks consumed almost 50 and 75 percent, respectively, of the set-up for noncardiac and cardiac cases, with drug preparation far outweighing drug administration tasks.

Often, anesthesiologists found it difficult to acquire needed drugs due to poorly organized anesthesia carts and mislabeled or illegibly labeled medications. Their work surfaces, typically the top of the anesthesia cart, were small and usually cluttered. Added to these drug preparation problems were administration problems such as infusion device failure, leaking or maladjusted stopcocks (which can interfere with intravenous fluid flow), and tangled intravenous lines. Existing infusion systems were bulky, heavy, awkward, and did not communicate effectively with each other or other medical devices.

Improving anesthesia supply systems and development of new technologies for drug packaging, drug/fluid delivery, and information management are critical to improving anesthesia care, conclude the researchers. The research team was led by Matthew B. Weinger, M.D., director of the San Diego Center for Patient Safety and professor of anesthesiology at UCSD.

See "Reengineering intravenous drug and fluid administration processes in the operating room," by Deborah B. Fraind, B.S., Jason M. Slagle, M.S., Victor Tubbesing, B.S., and others, in the July 2002 Anesthesiology 97(1), pp. 139-147.

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