Propofol Disposal in the Anesthesia Setting: Overcoming Barriers.

Propofol accounts for 41% of reported substance abuse cases among anesthesia providers. No guidelines outline appropriate propofol disposal in the healthcare setting. The lack of controlled disposal presents concerns for environmental harm, economic waste, and diversion. An evidence-based practice project was conducted in a large, Midwestern teaching institution to address propofol disposal. Data collected regarding propofol waste and from a survey indicated that Certified Registered Nurse Anesthetists (CRNAs) have limited access to sinks in the operating rooms for disposal, have environmental concerns regarding pouring propofol into the sink, and find propofol vials difficult to open. Interventions tailored to address these barriers included implementing a specially designed bottle opener and activated carbon pouch in each operating room to be used for propofol disposal. A χ² analysis showed that changing CRNA practice from sink disposal to carbon pouch disposal significantly decreased the percentage of unemptied propofol vials remaining in unsecured bins from 25.8% before the intervention to 3.4% after the intervention (P < .0001). Decreasing access for diversion is critical for anesthesia practices, and removing barriers to disposal can help reduce access. This evidence-based practice project demonstrated how tailoring interventions to address identified barriers produced an effective practice change for propofol disposal.