Pfrimmer, Dale M.

BackgroundPropofol 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.Local ProblemObjectives 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.MethodsThe 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.ResultsSurvey 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.ConclusionFollowing institutional approval, this propofol disposal process was replicated in all intensive care units and the emergency department in the study institution.

The potential threat of a pandemic influenza outbreak has placed emergency preparedness in the health care spotlight. Hospitals are increasingly gearing up readiness plans in preparation. Most of these plans are related to the implementation of protocols and stockpiling of supplies, medications, and equipment. These plans are dependent on staff for implementation, but will nurses' duty to care for patients outweigh their competing obligations to their families and the risk of their own exposure? J Contin Educ Nurs 2009;40(2):53–54.