Waste II

This is a continuation of yesterday's post.

Part of anesthesia is anticipating emergencies and treating them timely. Clinical situations in the operating room can arise so quickly that we have to be ready to act at any time. Thus, for every case, I draw some "emergency drugs," mostly to control blood pressure. But if at the end of the day I have emergency medications I didn't use, I have to throw them out. I'm not sure how to reconcile this problem. Emergency vasopressors such as ephedrine or phenylephrine can take a minute or two to dilute and prepare, and in a critical situation, this time and distraction can lead to patient harm. After medications expire, they should be discarded. There's no way around this; in order to keep my patients safe, I have to draw medications I'm not sure I'll use. What happens to vials that are drawn but not used (or vials that are broken)? I assume the hospital simply absorbs the cost, and that too, is another reason why hospital finances can be so tricky.

It's not just a problem with drugs. In the same way, prior to intubating a patient, I have two different laryngoscope blades available, one as a rescue blade if I run into trouble. I always have both available, but rarely have to resort to the backup. I used to take out two oral airways until we had a shortage; now I am a lot more conscientious of producing unnecessary waste. I used to have two sizes of endotracheal tubes available, but now I think of each patient to decide whether I need to have multiple prepared. These are all instances where I prepare more than the minimum equipment, thus using resources and my time. But a lot of these, at least in this stage of my training, seem to be necessary to ensure patient safety.

All I can do is to be aware of how much I use and how much I waste, and within the confines of what is safe for the patient, minimize anything unnecessary.