Letters to the Editor: Letters & Announcements
As emphasized in the discussion of our paper,1 there are “methods we have not considered or which may not be easily uncovered based on the examination of the database.” The documentation of “excess” amounts of narcotics not actually administered is an example of the latter, given the large number of possible surgical procedures and combinations of procedures.2 Furthermore, the companion paper by Vigoda et al. demonstrated significant discrepancies between their automated medication dispensing system and anesthesia information management system databases.3 Given that diversion is fairly uncommon, it is not surprising that we did not discover any additional examples of diversion using our system over an 8-mo period.
Finally, we do not follow Dr. Windokun's4 concern about the potential consequences of our publication on patient care, since neither outliers in mean administration nor wastage identified individuals diverting controlled substances.
Richard H. Epstein, MD
Professor of Anesthesiology
Jefferson Medical College
Thomas Jefferson University
1. Epstein RH, Gratch DM, Grunwald Z. Development of a scheduled drug diversion surveillance system based on an analysis of atypical drug transactions. Anesth Analg 2007;105:1053–60
2. Dexter F, Macario A. What is the frequency of uncommon ambulatory surgery procedures performed in the United States with an anesthesia provider? Anesth Analg 2000; 90:1343–7
3. Vigoda MM, Gencorelli FJ, Lubarsky DA. Discrepancies in medication entries between anesthetic and pharmacy records using electronic databases. Anesth Analg 2007;105:1061–5
4. Windokun A. Database analysis of atypical drug transactions. Anesth Analg 2008;106:1019