Epstein Richard H, Gratch David M, Grunwald Zvi
Department of Anesthesiology, Jefferson Medical College, Philadelphia, Pennsylvania, USA.
Anesth Analg. 2007 Oct;105(4):1053-60, table of contents. doi: 10.1213/01.ane.0000281797.00935.08.
Drug diversion in the operating room (OR) by anesthesia providers is a recognized problem with significant morbidity and mortality. Use of anesthesia drug dispensing systems in ORs, coupled with the presence of anesthesia or OR information management systems, may allow detection through database queries screening for atypical drug transactions. Although such transactions occur innocently during the course of normal clinical care, many are suspicious for diversion.
We used a data mining approach to search for possible indicators of diversion by querying our information system databases. Queries were sought that identified our two known cases of drug diversion and their onset. A graphical approach was used to identify outliers, with diversion subsequently assessed through a manual audit of transactions.
Frequent transactions on patients after the end of their procedures, and on patients having procedures in locations different from that of the dispensing machine, identified our index cases. In retrospect, had we been running the surveillance system at the time, diversion would have been detected earlier than actually recognized.
Identification of the frequent occurrence of atypical drug transactions from automated drug dispensing systems using database queries is a potentially useful method to detect drug diversion in the OR by anesthesia providers.
麻醉医护人员在手术室进行药品挪用是一个公认的问题，会导致严重的发病率和死亡率。在手术室使用麻醉药品调配系统，再加上麻醉或手术室信息管理系统的存在，可能通过数据库查询筛查非典型药品交易来实现检测。尽管此类交易在正常临床护理过程中是无害发生的，但许多交易都存在挪用嫌疑。
我们采用数据挖掘方法，通过查询我们的信息系统数据库来寻找可能的挪用指标。寻求能够识别我们已知的两例药品挪用病例及其发生时间的查询。采用图形方法识别异常值，随后通过对交易进行人工审核来评估挪用情况。
在患者手术结束后对其进行频繁交易，以及对在与调配机不同地点进行手术的患者进行频繁交易，识别出了我们的索引病例。回顾过去，如果我们当时运行监测系统，挪用情况会比实际发现的时间更早被检测到。
使用数据库查询从自动药品调配系统中识别非典型药品交易的频繁发生，是检测麻醉医护人员在手术室进行药品挪用的一种潜在有用方法。
