Overcoming a Crisis at Your ASC: 3 Scenarios

Day-to-day operations typically run smoothly at ASCs. Minor problems may arise, but a well-trained staff can handle them seamlessly.

However, no matter how prepared the ASC, a crisis may occur at the least opportune time.

Alisa Fischer, administrator of the St. Augustine (Fla.) Surgery Center, describes three crisis scenarios that occurred at her center and how they were handled.

Crisis #1: A broken sterilizer
Proper sterilization of instruments is an essential step of patient safety for all healthcare providers, including ASCs. So, what happens when a sterilizer breaks?

Ms. Fischer and St. Augustine Surgery Center faced just this problem. She describes the situation: "Both of our Steris machines, which are used to sterilize orthopedic cameras and scopes for cases, displayed warnings. We had a full day of orthopedic procedures requiring scopes."

Ms. Fischer and her staff faced some challenges. If the machine could not be fixed or if they could not come up with an alternative method, cases would have to be canceled. If the staff members proceeded with scopes and cameras that were not sterilized properly, they ran a risk of patient infection.

However, quick action eliminated some of the more serious risks, although the center did experience delays of 45 minutes.

Ms. Fischer outlines the steps the center took once the machine went down: "We immediately called the repairman and alerted the surgeons. We mixed a pan of CIDEX OPA, which is what used to be used to soak scopes prior to the invention of Steris machines. It is not state-of-art 'high level disinfection,' but for more than 20 years, it has been used successfully in ORs. We also called the equipment rep and local ASCs and hospitals to see if they had autoclavable scopes to borrow. Unfortunately, they did not.

"Thankfully, when the repairman came, one of the two machines met the criteria needed for sterilization, and we were able to continue with the cases," she adds.

Ms. Fischer thinks that by immediately calling for repairs and prioritizing alternative procedures for sterilization prevented a bad situation from getting any worse. She does note that better preparation could have helped the center reduce the wait time for patients. "If you are a busy orthopedics or urology center with a limited amount of Steris machines, you may wish to purchase back-up autoclavable scopes and sterile drapes," she says. As a result of this experience, Ms. Fischer says St. Augustine purchased two back-up autoclavable scopes with light cords and sterile camera drapes.

Crisis #2: Unauthorized prescription
When most patients leave the surgery center, they are given a prescription by their physician. Occasionally, pharmacies may call to verify a prescription or patient information. However, what should an ASC do they receive a call from a pharmacy for a prescription that could not have been issued from the surgery center?

St. Augustine Surgery Center faced this situation. Ms. Fischer says, "Wal-Mart pharmacy called asking which physician wrote the prescription for Zyban for a patient. Immediately, red flags when up: The patient's last visit was Sept. 2006, and Wal-Mart called in Jan. 2009."

Additionally, Ms. Fischer notes that Zyban is not a medication the physicians would typically prescribe post-operatively. Upon further investigation, it was discovered that the prescription was written on St. Augustine's prescription pads. The pharmacy also said that it could not read the physician's signature, and the prescription did not have a DEA number.

Ms. Fischer says the false prescription could mean a potential theft of prescription pads and potential fraud, if the patient copied the physician's signature, both of which could result in myriad problems for the ASC. "This could mean a breach in our policy of secure prescription pads and medication availability," she says. "We would have had to report potential identity theft. [The Florida Agency for Health Care Administration] could visit and impose a fine for lack of security, and perhaps this would jeopardize our pharmacy and DEA licenses."

St. Augustine Surgery Center took several steps to investigate what had happened. "We tracked down the patient through our software database to validate the patient was in the center," Ms. Fischer says. "We had the pharmacy send us a copy of the prescription. When we received the copy, we recognized the physician signature. We called the physician and found out that he had indeed written a prescription and admitted to having two blank center prescription pads in his lab coat pocket."

As a result of this breach, St. Augustine Surgery Center has limited the number of prescription pads in its narcotics cabinet to one. "We give the prescription pads to the physician when he asks for one. Extra prescription pads are stored separately in a safe and are counted and signed for," Ms. Fischer says.

Crisis #3: Appliance failure
Staff members at surgery centers expect their equipment to be working properly, especially when it comes to appliances such as refrigerators. However, it is important not to take for granted that everything is in working condition. So, what happens when you find that the medication refrigerator isn't working?

St. Augustine Surgery Center came in on a Monday morning to find this problem as part of its refrigerator daily check. "The medication refrigerator was at 65 degrees Fahrenheit," Ms. Fischer says. "Further inspection noted that the refrigerator was unplugged."

Ms. Fischer emphasizes the importance of discovering this problem. "If the staff had not done the daily medication refrigerator check, the items could have been used on patients and caused infections," she says. "Viscoat and Contigen (which are kept in the refrigerator) are both injected in patients."

Additionally, the surgery center would have to discard any medications kept in the refrigerator and face a potential increase in replacement medications.

In order to prevent any further harm to patients, staff members at St. Augustine Surgery Center immediately isolated the medications in the refrigerator. "The medication companies were called to ascertain in writing the shelf life of each medication involved at room temperature," says Ms. Fischer.

Learn more about St. Augustine Surgery Center.