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Anesthesia Cart Access Control – Lock or Unlock?

July 17, 2018

There are medical cart questions in healthcare that continue to be asked of me. One such consistent question for over fifteen years is:

Do Anesthesia Carts have to be locked in between patient cases?

Your healthcare facility’s accreditation is important. It may be a department of health, The Joint Commission (On Accreditation of Healthcare), or other. As The Joint Commission is most familiar to me I will utilize their standards and interpretations to answer this question, “Do anesthesia carts with medications have to be locked between patient cases?”

The simple answer is Yes.

Per the interpretation below – my interpretation thereof is that cart access must be secure when not controlled by monitored access to the carts. If the cart itself is in a controlled, secured, and monitored area (such as inside the OR), then the access to the carts themselves need not be secured in between cases. If the area is not monitored or secured to prohibit unauthorized access, then access in the cart (locking of cart drawers) or access to the cart (carts in secured room) must be maintained.

So in a typical Surgical department of a medical center you would have credentialed and monitored access to the department itself. A keypad, proximity access badge, and possibly a manned human security guard. This means the cart is “Secured.” So – access to the carts themselves are controlled – so the actual cart many be required to be “Locked” in between cases.

Here is The Joint Commission’s response to does an anesthesia cart with medications need to be locked between cases?

If the individual operating room is part of a larger OR unit that is manned at all times in a fashion which monitors access to the operating room and assures constant surveillance of the anesthesia cart to prohibit access by unauthorized individuals – locking of the cart between cases would not be required. After hours when the OR unit is not manned in a like manner, the carts must be properly secured. Whether the carts are locked or unlocked, they must be stored in a secured area which prohibits access and tampering by unauthorized individuals (e.g., in a separate locked room or in the secured OR unit where unauthorized access is prohibited.)

Here is where it becomes gray matter.

While the the cart(s) are in a controlled area between cases in the individual surgical suites, when custodian services come into to terminally clean the room post-op / pre-op, there is nothing preventing them from tampering or engaging in unauthorized access.

So if you are procuring new medical anesthesia carts – what type of access control is needed? It appears a lower level of access control is needed during operating hours than after operating hours unless all the carts are secured in a locked med room. As you cannot readily purchase anesthesia medical carts with two separate access control systems, it would be prudent to procure the comprehensive access control system for all phases of the cart’s life. During procedures, after procedures, in the evening and weekends, and all other times.

That is why around 2004 there was a paradigm shift in the anesthesia cart access control systems. Medical cart systems with credentialed access control, and often auto-locking features became the new standard. Additional features are individual credentialed (via pin number or unique proximity badge) access and audit trail capabilities to determine who entered when should there be a pattern of missing or unaccounted for items.

Anesthesia carts contain schedule one narcotics, and many other medications. Anesthesia medical carts should have the most reasonably advanced locking and auto-locking access control systems to promote safety and accountability.

Here is an article about Anesthesia Carts you may enjoy reading on American River Medical.

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