Implementation of a new method to track propofol in an endoscopy unit

Propofol is a widely used anesthesia induction agent and is easily accessible in most healthcare facilities. Unlike regulated or schedule drugs, propofol is inconsistently tracked, leading to inaccurate inventories, incorrect billing, and unrecognized diversion. The goal of this project was to implement a new method of tracking propofol in a single setting, with the aim of accounting for 100% of the drug.

For two, 2-week observation periods, data were extracted from an automated medication management system or pharmacy inventory system, anesthesia records, and pharmacy billing sheets for cases in a Gastrointestinal (GI) Endoscopy Unit, and compared pre-implementation and post-implementation of a new tracking and accounting protocol. Variables included amount of propofol inventoried, dispensed, administered, returned, billed, wasted, and missing.

Pre-implementation (n = 300), 10% cases had no record of propofol removal from the automated medication system. Of the 90% that did, 25% had an amount signed out that did not match the amount administered. Thirty-one percent of all propofol was unaccounted for during this 2-week period. Furthermore, 19.7% of cases did not have a billing form located. Post-implementation of the process change, unaccounted for propofol decreased to 26% of all cases (P = ns). The percentage of missing billing forms decreased from 19.7 to 5.8% (P = 0.00).

Data suggest notable amounts of propofol were unaccounted for and not billed for in the GI Endoscopy Unit prior to the protocol change. Post-protocol change data reveal modest improved accounting of the medication and significant cost-capture. Improvements may enhance inventory reconciliation, availability of drug stock, and potentially result in a decreased risk of unrecognized diversion.