Our surgical facility spends about $75,000 a year on anesthesia drugs. We've found that if we focus on how we buy, store and handle medications, we can save thousands and keep dangerous drugs secure. Here are the medication management tips that have worked well for us.

1. Know when and how much to order. Setting "order points" and "order quantities" for each medication your anesthesia providers need is a strategy for calculated inventory management. Determining these 2 numbers requires some research and some trial-and-error, but it can simplify your drug purchasing process and help to tame your supply budget.

Here's how it works. An order point is the number of units of a particular medication that your facility uses, plus enough to cover unexpected circumstances, during a specified length of time — namely, how long it takes to receive a replacement order of that medication. Let's say your providers use 25 vials of a drug per week, and 10 more vials would conservatively cover them against emergency situations. If it takes a week for the manufacturer to deliver a shipment of this drug, 35 vials is your order point, the point at which you should place an order (or set up an automated order to occur).

Once you've calculated your order point, you'll also want to figure out your order quantity, or how many units of a medication to purchase per order. This number, like the order point, is based on a consideration of your case schedule. But it's also influenced by how often you want to place orders, how long the medication lasts before its expiration date and whether any contracts you may have with manufacturers or distributors set minimum order requirements.

You and your materials manager should understand and agree upon these numbers, the order points and order quantities for each anesthesia drug. Post them in your supply room near each product's bin, like the stickers on the shelves in a supermarket's aisles, where the personnel assigned to check inventory can easily refer to them.

2. Store meds in wheeled wire racks. Calculations aside, one thing we've found extraordinarily useful in inventory management is to store as much as possible on wheeled wire racks. Their shelves don't collect as much dust, they're open so all items are visible from all sides and their mobility means you can pull them out and push them back into place, which can assist staffers who are rotating stock from the back (if you haven't yet adopted a "use-from-the-right, replace-from-the-left" strategy).

3. Just-in-time ordering. The concept of order points and order quantities can facilitate a just-in-time inventory process, which aims to keep you conscious of what and when you're ordering by keeping minimal stock on hand.

You don't want to have too much inventory around at any given time. Excess stock on your supply room shelves represents cash that is not necessarily working for you and your facility. Inventory doesn't earn interest, and if it's a product that expires or was requested by a surgeon who discontinues its use or stops practicing at your facility, then it's worth nothing. Plus, excess stock can lend itself to a staff that squirrels items away, which can be wasteful as well as a security risk.

4. Make sure everyone knows what drugs cost. From the rank-and-file staff to the highest level of administration, everyone should know what anesthesia products cost, and should be free to question these costs, since it pays to investigate. Adopt the principles of quality improvement: Plan, Do, Check and Enact. Expect occasional errors in over-ordering, under-ordering, budgeting or hoarding, but track those errors, find out how the situation can be improved and adopt those changes.

5. Ensure security. While you'd like to think that the people you hire to work in your ORs should be trustworthy enough not to steal drugs, recent news reports have generated a need for vigilance. Properly securing and accounting for your medications not only supports patient and employee safety at your facility, but it's also the law. You should be aware of regulations regarding the storage and handling of scheduled (or controlled) drugs, which are overseen by the federal Drug Enforcement Administration, and legend (or prescription) drugs, which fall under the domain of your state's board of pharmacy.

Federal law dictates different levels of security for the different classes of controlled drugs, ranging from storage in a locked cabinet in a secured area to simply storage in a secured area. Similarly, some classes of drugs require particular accounting in their use and disposal, with details witnessed and recorded. State laws vary, and while they can be stricter than the DEA's rules, none are less strict.

It may be necessary to reconcile the practical application of drug storage and handling at your facility with what the letter of the law requires. For example, ideally all medications should be locked up any time that licensed employees are not present. From a practical standpoint, however, repeatedly requesting and gaining access to a locked room can burden staff members. Also, propofol is not a federally scheduled drug, and therefore doesn't need to be stored in a locked cabinet at all times, but some professional organizations feel it should be, and many providers and facilities do lock it down. Consult with your pharmacist or pharmacy consultant to develop policies for your facility that not only ensure secure handling, but also comply with government regulations.

6. Rules of the case cart. Between drug storage and drug administration is the anesthesia provider's case cart. It must be lockable in order to secure the items under a provider's responsibility in the event he steps away. Today's anesthesia carts offer several locking mechanisms. They employ keys, swipe cards, passcodes, thumbprint recognition, even retina scans to secure their contents. No matter which method your carts use, though, it's critical to regulate secondary access by assigning authorization to open the cart in the event that the anesthesia provider is incapacitated and must leave the procedure.