Are You Trading Efficiency for Safety in Your ASC?

By Kelly Dragon, MSN, RN

It’s an exciting time for ambulatory surgery centers (ASC). ASCs have become central to the healthcare delivery system, and the market is ripe for innovation and growth. Outpatient facilities that provide surgical services offer patient satisfaction through lower costs and shorter stays. Providers gain efficiency and increased throughput.

A compact ASC staff serves a high volume of patients, and team members often wear multiple hats. Employees are given greater latitude to take quick, decisive action … but is this flexibility too much of a good thing? Flexibility translates to freedom, but freedom also has the potential for risk.

An ASC staff with increased responsibility for multiple facets of operations could lead to breadth and not depth, and a critical area that cannot afford to lose depth is medication safety.

ASCs are responsible for ensuring the safe administration and handling of medications, including high-risk drugs like controlled substances, anesthetics, and biologics.  Maintaining stringent medication safety protocols is essential to minimize medication errors, drug diversion, and adverse patient outcomes.

Know your scope 

Accreditation Commission for Health Care (ACHC) survey data reveal that ASC staff often have difficulty aligning their position descriptions with the reality of their daily tasks. Surveyors noted that, upon interview, employees listed duties that reached beyond their defined scope of practice.

ASC nurses and other staff members are responsible for carrying out medical orders, but they are not authorized to make medical decisions or prescribe medications. Communicate with your staff. Do they ever feel pressured to make decisions outside of their clinical scope? Empower personnel to speak up when encountering vague or conflicting orders, such as those that leave “room for interpretation.”

Avoid putting staff in this position by ensuring that medical orders are clear, complete, and unambiguous. Lack of specificity sets the scene for medication errors. For example, pain management orders should specify the type of medication and the conditions under which it should be administered, such as “Fentanyl 25mcg every 5 minutes for moderate pain,” or “Dilaudid 0.5mg every 5 minutes for severe pain.”

Know your patient

An unequivocal, straightforward medical order paves the way for proper pain assessment. Before administering pain medications, document the patient’s pain level and ensure that medications are given according to the patient’s needs. After administering pain relief, assess pain at agreed-upon intervals, and document the effectiveness of the medication.

ASCs are responsible for ensuring that patients’ pain levels are adequately assessed and managed before, during, and after procedures. Ensure that every step is followed, even on the busiest day. Develop policies and procedures with clear parameters for pain scoring and intervals at which pain is assessed.

Conduct pain assessments regularly and establish clear definitions of pain intensity. For example, your policies may define mild pain as a pain score of 1-3, moderate pain as 4-6, and severe pain as 7-10.

Both the American Society of PeriAnesthesia Nurses (ASPAN) and Association of periOperative Registered Nurses (AORN) provide evidence-based recommendations for optimal pain management practices and assessment intervals.

Know your process

Labeling, documentation, storage, and infection control: these individual elements come together to form a sturdy, proactive defense against common medication safety pitfalls. Thoroughly train staff on your organization’s process and regularly assess competencies.

Clearly label medications with the name, dose, the person who prepared it, the date and time, and any other relevant details. This labeling process ensures that medications are easily identified, which is particularly important when multiple medications are prepared for different patients during the same surgical session. Thoroughly train staff members in labeling and double-checking medications before administration.

Accurate documentation is a crucial component of medication safety in ASCs. Detailed records must be maintained for every medication administered to a patient, including the dose, time, and the identity of the healthcare provider who administered it. Documentation should also capture any adverse reactions or complications associated with the drug, which is vital for patient care continuity and legal purposes.

When using multi-dose vials, store them according to national safety standards. Keeping medications stored and handled according to guidelines helps prevent medication mix-ups and ensures patient safety. Reduce the risk of contamination; do not store opened vials in patient care areas.

The CDC provides specific guidelines that help minimize the risk of infections related to medication administration. A key practice is the “scrub the hub protocol,” which involves using alcohol to disinfect the access points of medication vials and intravenous (IV) ports before use. This simple but crucial step helps prevent contamination and reduce the risk of healthcare-associated infections (HAI).

Know your risk

Controlled substances such as opioids, benzodiazepines, and anesthetics carry a higher risk for drug diversion. Regulatory bodies (including CMS) and accrediting organizations (such as ACHC) have established clear standards for handling these drugs in ASCs. Prevent drug diversion by tracking the receipt, storage, and disposition of all controlled substances.

Develop standard operating procedures that include maintaining accurate records of drug deliveries, quantities received, and the movements of controlled substances within the facility. Store controlled substances in a secure environment, such as a locked medication room, an electronic medication dispensing system (e.g., Pyxis machine), or a double-locked cabinet. These systems allow for controlled access and maintain a record of who accessed the drugs, when, and for what purpose.

Regular inventory checks are essential to maintaining accountability. Count controlled substances at specific times—such as daily, at the beginning and end of shifts, upon receiving drug deliveries, and when drugs are removed or disposed of (e.g., expired medications). Two licensed providers should always witness and verify the disposal or return of these drugs. These procedures help mitigate the risks of diversion and ensure that drugs are accounted for at all stages of their use.

Know your priorities

Ambulatory surgery centers benefit from employing highly educated professionals and operating with maximum efficiency. However, efficiency should not come at a cost to quality patient care. Minimize your organization’s risk by implementing effective medication safety practices. Prioritize clear communication, ongoing education, specific policies, and well-defined processes. By following national guidelines and maintaining robust safety protocols, ASCs can continue to provide safe and effective care for patients undergoing outpatient surgical procedures.

Kelly Dragon, MSN, RN is a clinical review specialist, and ambulatory surgery center surveyor with Accreditation Commission for Health Care (ACHC). She has 17 years of nursing experience in both hospital and ambulatory environments. Her background includes obstetrical nursing, perioperative nursing, and adjunct clinical teaching.