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watched. Safe injection practices also make a good quality assessment and performance improvement project.” Medication use is

another chal-

lenging issue for ASCs that is receiv- ing increased attention, Mitros says. “If you look at the reasons why ASCs struggle on surveys, it often revolves around medication usage and inap- propriate storage. Your anesthesia pro- vider is likely already well-versed on these issues, so make sure to involve them if your ASC needs improvement with medication-related standards.” Management of medication is another common pitfall for ASCs, Wherry says. “Oftentimes, anesthesia personnel may not realize how many of their supplies expire. This includes not just intravenous (IV) fluids, but also endotracheal tubes, for example. Anesthesia carts can accu- mulate materials and medicines over time. It would be of great value for anes- thesia to regularly clean those carts. This

is a quick fix that will help you avoid get- ting dinged during a survey.”

Another area relating to medication often in need of extra attention is medication reconciliation, Koch says. “You must be able to track medications coming into the facility, what is given to patients and what is being circulated out due to expiration. That fastidious approach is not always as optimal as it should be. Work with your anesthesia personnel on improving medication labeling. This will help to establish a culture of better documentation of what is happening to medication.” Mitros notes that malignant

hyperthermia (MH) is almost always an issue addressed during a survey, and should be one that involves anes- thesia. “For an anesthesiologist, MH is part and parcel of what you learn from day one in your residency.” Koch says anesthesia personnel, who have a broad understanding of


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the perioperative process, are in the perfect position to help with another often challenging accreditation issue: credentialing and privileging. “You must ensure that the folks

providing services—be it nursing, surgical or anesthesia—are privileged for those procedures,” he says. “Those privileges must be looked at frequently, and these providers must meet the minimum standards for reappointment. Anesthesia is present during procedures and can provide valuable insight on competencies.” If you want anesthesia personnel’s assistance with tackling accreditation challenges, make sure to give them a copy of the accreditation standards, Wherry advises. “They should have a current copy of the standards, partic- ularly those that pertain to them. Sit down with the anesthesia team, review each standard and make sure everyone is on the same page for compliance.”

Lean on Anesthesia Since ASCs, by design, have fewer administrative resources and staff avail- able to them than other organizations, such as hospitals, Mitros says, they can- not afford not to involve their anesthesia personnel in accreditation efforts. That involvement should extend to

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as many accreditation-related issues as possible, Wherry says. “At the ini- tial survey meeting and summation conference at the end of a survey, to the degree that anesthesia can be there and involved will mean a lot to sur- veyors. They are looking for not just the nursing director and administrator to be concerned about compliance. If you have a contracted provider equally involved, surveyors will feel more comfortable that the ASC is run well and has a lot of good people involved.” Koch adds, “Anesthesia personnel

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