A strategy to prevent substance abuse in an academic anesthesiology department.

Substance abuse is the most serious occupational safety issue associated with the practice of anesthesiology, with an incidence as high as 1% per year of training. The Cleveland Clinic's Anesthesiology Institute approached the process from the perspective of active prevention, including specific mandatory education programs for all department personnel on a recurring basis, strengthened procedures for the detection and prevention of diversion of controlled substances, enhanced skill building for detection of impairment, and implemented a multi-faceted drug testing program, including random and "for cause" urine screens, for prevention and early detection of abused anesthetic drugs and other substances of abuse. After 18 months of preparation, a Substance Abuse Prevention Protocol was created, which has been fully implemented as of September 1, 2007.