Propofol waste

[UscGhost]

Our administration is trying to push a policy that requires wasting propofol similar to how we waste narcotics (requires a witness, etc)

Given the negative affects on workflow (especially in GI) as well as the complete lack of accuracy when wasting when using propofol drips, etc...I am pushing back.

Additionally it will just become a wasted exercise as the nurses will just be blindly witnessing because they won't be familiar with dosing, etc.

I wanted to ask if anyone here currently has to waste propofol, what issues they encountered, and if they were successful if pushing back.

Any help is appreciated.

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[JoelJoel84]

Propofol is not a controlled substance, so you will not be wasting it , similar to how you do not waste LR or saline.

At least that’s what I said at our hospital when they tried a similar request.

 

[anaesthetic]

I work at different hospitals, one requires propofol wasting and one does not. Some patients get a lot more propofol than others.

 

[jwk]

We've been required to document propofol like other controlled substances for many years in Georgia. It's just not that big a deal. All of our propofol is given via syringe or syringe pump, so documenting waste is simple. Concern about nurses blindly witnessing is no different than them witnessing any other drug waste. BTW - all our drug waste is done in the procedure room at our Accudose anesthesia work station.

There is certainly abuse potential with propofol, whether it's scheduled or not.

 

[UscGhost]

We've been required to document propofol like other controlled substances for many years in Georgia. It's just not that big a deal. All of our propofol is given via syringe or syringe pump, so documenting waste is simple. Concern about nurses blindly witnessing is no different than them witnessing any other drug waste. BTW - all our drug waste is done in the procedure room at our Accudose anesthesia work station.

There is certainly abuse potential with propofol, whether it's scheduled or not.

Abuse potential doesn't change by requiring a wasting. Those systems are easy to circumvent. Which is why narcotic diversion is still a significant issue regardless of long standing waste requirements.

I am just trying to avoid unnecessary administrative burden.

 

[anbuitachi]

if propofol requires waste. just make sure you use all of it. it'll always be divisible by 200mg

 

[MirrorTodd]

I work at different hospitals, one requires propofol wasting and one does not. Some patients get a lot more propofol than others.

Same. Coincidentally, I've gotten very good at propofol wakeups.

 

[nimbus]

I do a lot of propofol infusions using 100ml bottles and the Plum pump. I have no idea what the prime volume is for the Plum pump tubing so I have no idea how much propofol is being wasted. Thankfully we don’t document propofol waste.

 

[deleted875186]

I waste propofol. It is annoying, especially with a GI room. Most charts have 200 mg propofol or a multiple thereof, which completely defeats the purpose of the waste system. Requiring wasting does not do anything to prevent abuse, yet we still do it for opioids and benzos. I simply don’t understand why hospitals would want to treat prop as a controlled substance.

 

[Iso4ane]

I work at different hospitals, one requires propofol wasting and one does not. Some patients get a lot more propofol than others.

‘So the 80kg marathon runner got 200mg of Propofol?’
“Yep.”
‘And the 40kg elderly dementia patient also got 200mg of Propofol?’
“Yep, but she also need a little phenylephrine, but she did fine.”

 

[DocVapor]

I swear I developed a propofol allergy. Back when I had to waste it I was constantly sneezing, usually with associated involuntary muscle contractions resulting in the pillow being given a dose of propofol towards the end of a case.

I still haven't figured out why it stopped now that I don't have to waste it anymore.

 

[Dr. Rude]

I waste propofol. It is annoying, especially with a GI room. Most charts have 200 mg propofol or a multiple thereof, which completely defeats the purpose of the waste system. Requiring wasting does not do anything to prevent abuse, yet we still do it for opioids and benzos. I simply don’t understand why hospitals would want to treat prop as a controlled substance.

Perception of doing something.

 

[MirrorTodd]

I swear I developed a propofol allergy. Back when I had to waste it I was constantly sneezing, usually with associated involuntary muscle contractions resulting in the pillow being given a dose of propofol towards the end of a case.

I still haven't figured out why it stopped now that I don't have to waste it anymore.

It's psychosomatic. You need a lobotomy. I'll get a saw.

 

[pocafx]

someone complained about 1/2 full propofol in the sharps so now I squirt it in the med waste bucket. No witness
Or the trash if feeling lazy

 

[Urzuz]

if propofol requires waste. just make sure you use all of it. it'll always be divisible by 200mg

This is the correct answer.

 

[nimbus]

Wasting drugs with a witness is completely worthless and a waste of time. Any motivated person can fake the waste. Mix 100mg propofol with 5ml saline and it looks exactly like 150mg. We waste opioids and, as we know, people easily divert them too.

The way to prevent diversion is by returning them to pharmacy and assay every sample. But that is too costly.

 

[norski]

This is the April fool's joke made by every dept head in Norway. Works every single time.

 

[deleted875186]

Wasting drugs with a witness is completely worthless and a waste of time. Any motivated person can fake the waste. Mix 100mg propofol with 5ml saline and it looks exactly like 150mg. We waste opioids and, as we know, people easily divert them too.

The way to prevent diversion is by returning them to pharmacy and assay every sample. But that is too costly.

Or you have pharmacy examine records for trends in prescribing, would be much more likely to pick up someone that is diverting medicines.

 

[nimbus]

Or you have pharmacy examine records for trends in prescribing, would be much more likely to pick up someone that is diverting medicines.

Yeah for sure. But that puts the onus on them. They’d rather make us go through useless nonsense so they can say they’re doing something.

 

[ranvier]

Always cracks me up when asc#1 wants me to waste ephedrine and asc#2-4 have a pile of the vials and don’t care.

 

[nimbus]

Always cracks me up when asc#1 wants me to waste ephedrine and asc#2-4 have a pile of the vials and don’t care.

Maybe someone who worked there before was running a meth lab.

 

[anaesthetic]

Same. Coincidentally, I've gotten very good at propofol wakeups.

I like to give some patients propofol 50-80 mg IT post-emergence (intratrashously). Consider it wasted.

 

[epidural man]

One of the most satisfying times I ever had doing anesthesia was in Ass-crackistan.

I didn't keep a record (when doing anesthesia on the Afghanistan people - no one would ever see it anyway).

We had a massive bottle of fentanyl and me and the CRNA would just draw out what we needed and write on the bottle how much we took out, and we hid the bottle in a drawer no one could ever find (so it wasn't locked up).

NO PACU orders were ever written. I dropped the patient off, told them what I did, and said (well, not really, but this was implied) "do you what you know how to do!" (If the patient is cold, warm them. If they are shivering, give them some Demerol, if they are in pain treat it).

Not only do I feel like my care was better because ALL I did was pay attention to the patient and nothing else, but it was immensely liberating.

It's crazy how all the crap we have to do actually makes care worse.

 

[Onefellswoop87]

It's psychosomatic. You need a lobotomy. I'll get a saw.

“I’d rather have a bottle in front of me than a frontal lobotomy”

 

[ak_ps]

No wasted propofol when you push syringe until it stops...

 

[GassYous]

One of the most satisfying times I ever had doing anesthesia was in Ass-crackistan.

I didn't keep a record (when doing anesthesia on the Afghanistan people - no one would ever see it anyway).

We had a massive bottle of fentanyl and me and the CRNA would just draw out what we needed and write on the bottle how much we took out, and we hid the bottle in a drawer no one could ever find (so it wasn't locked up).

NO PACU orders were ever written. I dropped the patient off, told them what I did, and said (well, not really, but this was implied) "do you what you know how to do!" (If the patient is cold, warm them. If they are shivering, give them some Demerol, if they are in pain treat it).

Not only do I feel like my care was better because ALL I did was pay attention to the patient and nothing else, but it was immensely liberating.

It's crazy how all the crap we have to do actually makes care worse.

One advantage of having a surgicenter with no EMR is that the nurses will immediately come over and hook up the monitors. I hate watching the pacu nurse just sit there on their computer doing their ridiculous charting instead of actually caring for the patient. The good ones still come over right away but it creates an unnecessary distraction and gives the nurse an excuse to sit on their ass. Bonus points when they say "I didn't have a chance to look up the patient yet."

 

[jwk]

One of the most satisfying times I ever had doing anesthesia was in Ass-crackistan.

I didn't keep a record (when doing anesthesia on the Afghanistan people - no one would ever see it anyway).

We had a massive bottle of fentanyl and me and the CRNA would just draw out what we needed and write on the bottle how much we took out, and we hid the bottle in a drawer no one could ever find (so it wasn't locked up).

NO PACU orders were ever written. I dropped the patient off, told them what I did, and said (well, not really, but this was implied) "do you what you know how to do!" (If the patient is cold, warm them. If they are shivering, give them some Demerol, if they are in pain treat it).

Not only do I feel like my care was better because ALL I did was pay attention to the patient and nothing else, but it was immensely liberating.

It's crazy how all the crap we have to do actually makes care worse.

When I started in practice, pentothal came in 2.5 or 5gm bottles of powder that was reconstituted with saline. We drew out of that bottle till it was empty, whether that took 3 hours or 3 days.

 

[kidthor]

One advantage of having a surgicenter with no EMR is that the nurses will immediately come over and hook up the monitors. I hate watching the pacu nurse just sit there on their computer doing their ridiculous charting instead of actually caring for the patient. The good ones still come over right away but it creates an unnecessary distraction and gives the nurse an excuse to sit on their ass. Bonus points when they say "I didn't have a chance to look up the patient yet."

Extra points also for when they take out the nasal trumpet and remove the oxygen as a pre-monitor bonus move, then ignore the now fully obstructed patient with a sat in the 60s while charting.

Extra extra points for them using that temporal thermometer and settling on 35.1 as the actual patient temp.

 

[GassYous]

Extra points also for when they take out the nasal trumpet and remove the oxygen as a pre-monitor bonus move, then ignore the now fully obstructed patient with a sat in the 60s while charting.

Extra extra points for them using that temporal thermometer and settling on 35.1 as the actual patient temp.

There's one nurse I just can't stand who always has an excuse for why she can't put the monitors on. "Oh I need to get the paperwork." "Oh I don't have gloves on." Always calling me for nonsense "Can I give toradol to this patient with a large raw surface for her 3/10 pain?"

I had a postop patient that was breathing just fine with the head in a good position satting 99% and this lady just cranks on her jaw, nearly dislocates it and causes obstruction. When the sat starts dropping I tell her to let go, put the patient's head back to where it was and magically everything improves. Annoys the hell out of me.

But yea wasting propofol is stupid. Administrators will do anything to justify their jobs.

 

[drmwvr]

I waste propofol. It is annoying, especially with a GI room. Most charts have 200 mg propofol or a multiple thereof, which completely defeats the purpose of the waste system. Requiring wasting does not do anything to prevent abuse, yet we still do it for opioids and benzos. I simply don’t understand why hospitals would want to treat prop as a controlled substance.

Wait till they figure out you can huff liquid agent. They'll be having pharmacy transfer sevo and forane to graduated containers.

 

[nimbus]

At my training program, PACU nurses always had the monitors in hand and ready to go when we rolled in. I haven’t seen that since I left. Nowadays they’re almost never ready for the patient when we arrive but they still get upset when we forget to call ahead. I mistakenly thought the point of calling ahead was so they can be ready for patient arrival.

 

[epidural man]

I wonder what the impetus is to waste prop. What are the problems that the pharmacy has seen that they think they are fixing documenting waste? Has anyone asked this question of them? I just didn’t know there was a problem with propofol.

 

[deleted875186]

I wonder what the impetus is to waste prop. What are the problems that the pharmacy has seen that they think they are fixing documenting waste? Has anyone asked this question of them? I just didn’t know there was a problem with propofol.

There have been anesthesiologists and CRNAs that abuse propofol, although rare, I think this is the only rationale.

 

[GassYous]

At my training program, PACU nurses always had the monitors in hand and ready to go when we rolled in. I haven’t seen that since I left. Nowadays they’re almost never ready for the patient when we arrive but they still get upset when we forget to call ahead. I mistakenly thought the point of calling ahead was so they can be ready for patient arrival.

Exactly! Can't be too fast or too slow or they complain. "I've been waiting forever for you!" Oh ok so you were planning on doing something other than sitting there? Not sure what you're complaining about.

 

[shepardsun]

At my old institution a temp hire EVS worker was found unconscious in the bathroom with bloody syringes containing propofol. Camera footage from the ORs captured them scrounging through the sharps containers for unemptied syringes. We had to waste propofol after that and it was a huge pain in the rear.

 

[repititionition]

There have been anesthesiologists and CRNAs that abuse propofol, although rare, I think this is the only rationale.

Not that rare, also more deadly (faster average interval from abuse to death) than opioid or benzo abuse.

 

[fadedrebel]

It's psychosomatic. You need a lobotomy. I'll get a saw.

Love it. This reference takes me back to when I was a kid.

 

[GassYous]

Love it. This reference takes me back to when I was a kid.

I just bought a bunch of old books and am rereading

 

[thinkorswim]

Nowadays they’re almost never ready for the patient when we arrive but they still get upset when we forget to call ahead. I mistakenly thought the point of calling ahead was so they can be ready for patient arrival.

It’s probably part of the job description to act flustered when a patient arrives, regardless of how much advance notice has been given.

Another universal PACU protocol is that the bed spot told to the OR over the phone, the one written on the board, and the one where the patient actually ends up in must all be different numbers.

 

[thinkorswim]

There's one nurse I just can't stand who always has an excuse for why she can't put the monitors on. "Oh I need to get the paperwork." "Oh I don't have gloves on." Always calling me for nonsense "Can I give toradol to this patient with a large raw surface for her 3/10 pain?"

We have one gem of a PACU nurse that expects patients to be awake and ready for discharge within 5 minutes of arrival. It gets especially absurd on evenings or weekends when I’ve been asked to “give something to reverse” the propofol from a GI/MAC case (has happened on multiple occasions).

 

[The Duck Knows]

We have one gem of a PACU nurse that expects patients to be awake and ready for discharge within 5 minutes of arrival. It gets especially absurd on evenings or weekends when I’ve been asked to “give something to reverse” the propofol from a GI/MAC case (has happened on multiple occasions).

Would a few sips of viscous cocaine do the trick?

 

[nimbus]

We have one gem of a PACU nurse that expects patients to be awake and ready for discharge within 5 minutes of arrival. It gets especially absurd on evenings or weekends when I’ve been asked to “give something to reverse” the propofol from a GI/MAC case (has happened on multiple occasions).

👇

What a breathtaking failure of critical thinking and lack of understanding.

 

[C4C]

HCA started this nonsense. They claimed they were losing millions of dollars a year in unbilled propofol.

It seems to me the proper response from our end is to make sure that at the end of the day a large number of 20-cc wastes (attributable to no patient) are sclerosing the log. If they see that they are wasting money by wasting our time, it's possible that they may rethink the policy.

Good luck.

 

[GassYous]

HCA started this nonsense. They claimed they were losing millions of dollars a year in unbilled propofol.

It seems to me the proper response from our end is to make sure that at the end of the day a large number of 20-cc wastes (attributable to no patient) are sclerosing the log. If they see that they are wasting money by wasting our time, it's possible that they may rethink the policy.

Good luck.

I just chart enough to not deal with any waste nonsense

 

[Iso4ane]

HCA started this nonsense. They claimed they were losing millions of dollars a year in unbilled propofol.

It seems to me the proper response from our end is to make sure that at the end of the day a large number of 20-cc wastes (attributable to no patient) are sclerosing the log. If they see that they are wasting money by wasting our time, it's possible that they may rethink the policy.

Good luck.

You can blame JACHO, their policy is to throw out drugs that have been drawn up more than one hour.

 

[2Fast2Des]

You can blame JACHO, their policy is to throw out drugs that have been drawn up more than one hour.

I'm curious what happens in the ICU, do they throw away propofol infusion or any drug every hour to make sure it's fresh?

 

[sleepdoc2u]

This is the correct answer.

The whole exercise is just one more piece of bureaucratic nonsense. It doesn't prevent diversion, nor does the waste of controlled drugs. If someone wants to divert, they will divert. It just adds to wasted time and energy. It's one more useless task causing us to dislike our specialty.

 

[jwk]

The whole exercise is just one more piece of bureaucratic nonsense. It doesn't prevent diversion, nor does the waste of controlled drugs. If someone wants to divert, they will divert. It just adds to wasted time and energy. It's one more useless task causing us to dislike our specialty.

It's a little bit of a pain, but honestly just not that big a deal. In GA, propofol is treated as a controlled substance, so it's documented like all our other controlled substances. All we need is a fingerprint scan from another licensed provider (nurse, MD, CAA, doesn't matter) and squirt it in the big blue box.

 

[Simba1711]

There is a well known academic hospital on the east coast where you have to rent out your controlled substances which include narcotics and propofol. Of course you have to tally up and waste the propofol with the pharmacist at the end of the day. None of the Pyxis machines in the operating rooms contain propofol which is overkill. Along with being an induction agent I consider propofol an Emergency drug so I never really understood this.

On the topic of interruptions to workflow. Our admins wants us to scan each drug vial before we administer the medication. Of course , this means they also want us to not predraw our induction agents or emergency meds. These people are so clueless. This is at a asc.

 

[UscGhost]

It's a little bit of a pain, but honestly just not that big a deal. In GA, propofol is treated as a controlled substance, so it's documented like all our other controlled substances. All we need is a fingerprint scan from another licensed provider (nurse, MD, CAA, doesn't matter) and squirt it in the big blue box.

It's just another additional small burden on top of the multitude of small burdens. Not necessarily back breaking by itself, but adds up.

I am just vehemently opposed to additional red tape that serves no legitimate purpose, makes timely patient care more difficult, and is easily circumvented by those it aims to prevent from abusing.