Michael T. Ring is a nurse manager at Mayo Clinic, Rochester, Minnesota.
Dale M. Pfrimmer is a hospice patient care coordinator at Mayo Clinic.
Crit Care Nurse. 2021 Dec 1;41(6):45-53. doi: 10.4037/ccn2021123.
Propofol is a drug of diversion because of its high-volume use, lack of prescribed control mechanisms, and accessibility. As a result, intensive care unit nurses and other health care professionals are placed at unnecessary risk. Decreasing the risk of drug diversion can save lives, licenses, and livelihoods.
Objectives were to reduce the risk of drug diversion and diminish the environmental impact of medication discarded down the sink. Disposing of residual propofol into activated carbon pouches was successful and sustainable in operating rooms at the study institution. Literature findings supported this intervention because of propofol's potential for abuse, ongoing diversion events, ease of access, poor control mechanisms, lack of standardization, excessive waste, and ecological impact.
The intensive care unit with the highest propofol use was selected to replicate the propofol disposal process used in the operating rooms. Activated carbon pouches and bottle cap removal tools were located in each intensive care unit room at the nurses' workstation for ease of use. Audits of unsecured waste bins and staff surveys of institutional policy awareness, disposal processes, barriers, and concerns were completed before and after the intervention.
Survey results determined significant concern for drug diversion risk. The pilot project displayed success: 44.1% of propofol bottles in waste bins were full before the intervention and 0% were full afterward.
Following institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.
由于异丙酚的大量使用、缺乏规定的控制机制以及易于获取，它成为了一种易被滥用的药物。因此，重症监护病房的护士和其他医护人员面临着不必要的风险。降低药物滥用的风险可以挽救生命、执照和生计。
目标是降低药物滥用的风险，并减少因丢弃药物而对环境造成的影响。在研究机构的手术室中，将剩余的异丙酚装入活性炭袋中进行处理是成功且可持续的。由于异丙酚具有滥用潜力、持续发生的滥用事件、易于获取、控制机制不佳、缺乏标准化、浪费严重以及对生态环境的影响，文献研究结果支持了这一干预措施。
选择异丙酚使用量最高的重症监护病房，复制在手术室中使用的异丙酚处理流程。在每个重症监护病房的护士工作站，放置活性炭袋和瓶盖移除工具，方便使用。在干预前后，对未上锁的垃圾桶进行审核，并对员工进行机构政策意识、处理流程、障碍和关注点的调查。
调查结果显示，员工对药物滥用风险的关注度非常高。试点项目取得了成功：干预前，44.1%的废弃垃圾桶中有满瓶异丙酚，而干预后则没有满瓶的。
在获得机构批准后，该异丙酚处理流程在研究机构的所有重症监护病房和急诊室中得到了复制。
