Survey of wastage from intravenous admixture in US hospitals

The purpose of this study was to assess current wastage from intravenous systems designed for intermittent use in US hospitals. Questionnaires were mailed to pharmacy directors at 1393 randomly selected hospitals. Respondents were asked to indicate their overall percentage intravenous wastage rate, intravenous admixture policies and procedures, and wastage rates for currently used intermittent intravenous drug delivery systems. If actual data were not available, respondents were asked to provide estimates based on their perceptions of waste. A total of 237 (17.0%) usable responses were returned. The mean intravenous wastage was 2.85% (+/- 3.40) for respondents who provided actual values and 4.28% (+/- 3.83) for respondents who provided estimated values. Lower mean wastage rates were found for hospitals which: (a) received written notification of discontinued intravenous systems; (b) had an elapsed time of less than or equal to 1 hour from discontinuation of the intravenous system to notification in the pharmacy; (c) actively retrieved discontinued intravenous systems from the nursing unit; and (d) had a daily return of discontinued intravenous systems to the pharmacy. Based on actual values provided by respondents, for 9 intravenous systems the mean wastage rates were lowest for commercially prepared intermittent systems such as frozen piggyback systems {1.5% (+/- 1.4)} and piggyback systems stored at room temperature {3.2% (+/- 5.2)}, and 4.4% (+/- 16.0) for nursing-activated ADD-Vantage systems. We expected that pharmacy managers would monitor waste regularly and be able to provide actual values for wastage rates. However, only 124 (53.3%) of the respondents provided actual data.(ABSTRACT TRUNCATED AT 250 WORDS)     

Cost of wastage in a hospital intravenous admixture program

The wastage in a hospital centralized pharmacy intravenous admixture program was assessed. The loss rate was similar during two separate 36-day study intervals, averaging 6.2% of intravenous admixture preparations, accounting for an estimated loss of $26,077 for the year. Discontinuation of intravenous therapy accounted for half of the returned intravenous admixtures. Patient unavailability, drug changes, and malfunction of intravenous equipment were also causes for returns. Improved communication between hospital ward units and pharmacy personnel as well as increased flexibility in admixture preparation scheduling may reduce wastage. Ultimately, pharmacists assigned to individual ward units as part of the unit-dose pharmacy dispensing system may resolve the problem.     

The effect of oral communication on intravenous wastage: talk is cheap

The authors describe decreases in wastage and return rates in their Pharmacy Service department in a 471-bed tertiary hospital. Through procedural changes in mixing and delivery schedules, stability updating, and daily communication with the Nursing Service, Pharmacy Service dropped from a 3.9% to a 1.44% wastage rate and from a 15.75% to an 8.2% return rate in a period of 17 months. The specific changes that led to this result are presented for consideration. The primary focus was on determining and noting accountability of involved staff members to decrease returns, missed treatments, and ultimately wastage of costly intravenous admixtures. The 0.9% wastage rate in the seventeenth month suggests that continued efforts may lead to further reductions.     

Computer program for comparing total costs of intravenous antibiotic regimens

A computer program for estimating and comparing the costs of intravenous antibiotic therapy is described, and a cost comparison of two antibiotic regimens using the program is demonstrated. Data unique to each antibiotic (e.g., dosage regimen, duration of therapy, need for pharmacokinetic monitoring, and acquisition cost per dose) are entered into the first part of the program (ABDATA) and combined with preprogrammed hospital-specific data, such as personnel and material costs, to produce an itemized list of the total cost of therapy. With the second part of the computer program (ABCOMP), antibiotic regimen costs that have been entered into ABDATA can be compared. Cost comparisons are made with the assumption that the antibiotic regimens have similar efficacy and toxicity. A sample cost comparison was performed using data from a recent study comparing the use of ceftazidime or tobramycin-ticarcillin therapy in the treatment of nosocomial pneumonia and bacteremia. The computer-generated cost comparison showed that although the unit cost of ceftazidime was more than the combined unit cost of tobramycin and ticarcillin, the total cost of a 10-day course of therapy with ceftazidime (which included personnel and material costs) was less than the cost of therapy with a combination of tobramycin and ticarcillin. A computer program that incorporates hospital-specific personnel and material costs with unit drug costs can be used to facilitate comparisons of the overall cost of intravenous antibiotic regimens.     

Exploring the intravenous narcotics and controlled drugs wastage and their financial impact: A descriptive single-center study

ObjectiveThe objectives of this study were to explore the wastage of narcotics and controlled medications and, their financial impact in a tertiary care setting over a one-year period.MethodologyThe study period was of one year, i.e., October 2020 – September 2021. The venue of study was a tertiary care hospital. The narcotic medications included Fentanyl, Tramadol, Morphine, and Meperidine. The controlled medications included Midazolam, Phenobarbital, Diazepam, Ketamine and Lorazepam. The annual consumption and wastage of the narcotic and controlled medications were documented using data report generated by narcotics and controlled medication in-charge pharmacist through the hospital’s online system. Data was reported using average, minimum and maximum values. Quantities of wastage is expressed in terms of ampoules. Costs per ampoule were calculated and expressed in both Saudi Riyal (SAR) and United States Dollar (USD). The study was approved by an ethics committee.ResultsThe annual wastage of narcotics was 3.19 % while the same for controlled medications was 21.3 %. An annual wastage of 3.81 % was reported for narcotics and controlled medications combined. The total wastage cost of narcotics and controlled medications was 15,443.1 SAR that was equivalent to USD 4085.5. Fentanyl 500mcg formulations had the highest consumption, i.e., 28,580 ampoules followed by Morphine 10 mg formulations, i.e., 27,122 ampoules. The highest ampoule wastage was observed for Morphine 10 mg formulations, i.e., 1956 ampoules. The highest % wastage was observed for Midazolam formulations, i.e., 29.3 %.ConclusionThe overall wastage was less than 5% of the total consumption, however, midazolam was observed to have the highest wastage. Shifting to prefilled syringes supplied by pharmacies, making protocols, and safely pooling costly drugs could result in significant savings.     

Personnel costs and preparation time in a centralized intravenous admixture program

The amount of time and the cost of personnel time associated with the preparation of injectable products were determined. A time study consisting of 9041 observations during a seven-day period was conducted to determine the amount of time required of pharmacists and technicians for the preparation of total parenteral nutrient (TPN) solutions, large-volume injectables, antibiotic admixtures, antineoplastic admixtures, and investigational drugs. The established times were used to calculate relative value units for each product line and to determine the cost of pharmacist and technician time associated with the preparation of each product line. Preparation times ranged from 3.7 minutes for an antibiotic admixture to 49 minutes for a pediatric TPN solution. Total personnel costs ranged from $0.71 for an antibiotic admixture to $10.70 for a pediatric TPN solution. The calculated relative value units indicated that existing departmental time standards did not allow sufficient time for the preparation of some products. Establishing relative value units and calculating the cost of personnel time associated with the preparation of injectable products can be helpful for comparing the cost of purchasing ready-to-use products with the cost of preparing the same products.     

某院静脉输液非整支用量药品对患者费用的影响分析

目的：分析静脉输液非整支用量药品对社会资源浪费、患者费用的影响,减少药品浪费,节约经济成本。方法：调取2015年每季度一个月（2月、5月、8月、11月）共4个月的数据,统计静脉输液非整支用量药品的处方,对非整支用量药品的科室、药品、药品类别进行统计分析。结果：静脉输液非整支用量药品处方共计136 621条。其中,儿科非整支用量药品情况较多,为69 956条（占51.20%）;非整支用量药品中,氯化钾药物非整支用量情况较多,为14 482条（占10.60%）;非整支用量药物种类中,水电解质类药物非整支用量情况较多,为22 372条（占16.38%）,结论：静脉输液非整支用量情况较多,非整支用量药品对患者费用具有一定影响。     

浅谈药品损耗情况及管理措施

目的进一步提高该院药品管理水平,降低药品报损率。方法对该院2006～2010年药品损耗状况和原因进行统计、分析,并对降低药品报损率的方法进行探讨。结果该院通过对药品进行科学合理的管理,药品损耗率由2006年的0.21%降至2010年的0.03%,但是关于药品超过有效期的损耗仍在70%左右,药品的破损和患者退药两方面的损耗率呈逐年上升的趋势,由4.3%升至24.72%,这方面的损耗是以后需加强管理的重点。结论该院的药品耗损率逐年呈下降趋势,但是还有进一步降低损耗的空间,只要对药品进行科学、合理的管理,药品损耗率能降低到最有效程度。     

静脉用药调配中心药品破损情况分析

目的分析我院静脉用药调配中心的药品破损情况,为降低药品破损率提供参考和建议。方法对2013~2014年我院静脉用药调配中心的破损药品数据进行整理归类、统计、分析药品破损的原因、品种及特殊药品的破损情况等。结果 2013~2014年我院静脉用药调配中心的药品破损率均为0.05%,工作流程中各个环节均有报损,其中最主要的原因为原装破损、摆药破损及人员操作不当。结论我院静脉用药调配中心的药品破损率较低,药品的破损不可避免,但可以通过分析原因找出对策,进一步降低破损率。     

Hospitalization costs and resource allocation in cholecystectomy with use of intravenous versus oral acetaminophen

Objective: To evaluate intravenous (IV) acetaminophen (APAP) vs oral APAP use as adjunctive analgesics in cholecystectomy patients by comparing associated hospital length of stay (LOS), hospital costs, opioid use, and rates of nausea/vomiting, respiratory depression, and bowel obstruction.

Methods: We conducted a retrospective analysis of the Premier Database (January 2012 to September 2015) including cholecystectomy patients who received either IV APAP or oral APAP. Differences in LOS, hospitalization costs, mean daily morphine equivalent dose (MED), and potential opioid-related adverse events were estimated. Multivariable logistic regression was performed for the binary outcomes and instrumental variable regressions, using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for continuous outcomes. Models were adjusted for patient demographics, clinical risk factors, and hospital characteristics.

Results: Among 61,017 cholecystectomy patients, 31,133 (51%) received IV APAP. Subjects averaged 51 and 57 years of age, respectively, in the IV and oral APAP cohorts. In the adjusted models, IV APAP was associated with 0.42 days shorter LOS (95% CI?=?–0.58 to –0.27; p?p?p?=?.0005), and lower rates of respiratory depression (odds ratio [OR]?=?0.89, 95% CI?=?0.82–0.97; p?=?.006), and nausea and vomiting (OR?=?0.86, 95% CI?=?0.86–0.86; p?Conclusions: In patients having cholecystectomy, the addition of IV APAP to perioperative pain management is associated with shorter LOS, lower costs, reduced opioid use, and less frequent nausea/vomiting and respiratory depression compared to oral APAP. These findings should be confirmed in a prospective study comparing IV and oral APAP.     

A standard aminophylline intravenous solution with flow rate label adapted to a manufacturer's standard solution

The development of a standard aminophylline intravenous solution system utilizing a flow rate label is described. The original system was developed using 500 mg aminophylline in 250 ml of 5% dextrose injection in a polyvinyl chloride bag (PVC). An ancillary label was developed to be affixed to the bag to assist in maintaining flow rates. Later, this system was adapted to a premixed solution prepared by Travenol Laboratories. The difference, though, was the fact that a solution of 400 mg theophylline (equivalent to 500 mg of aminophylline) in 250 ml of 5% dextrose solution (PVC) was used. Hence, a new auxiliary label indicating flow rates between aminophylline and theophylline was developed. The success of both systems gave us more advantages than disadvantages. This was especially true with the premixed system. We feel that the auxiliary flow rate label helped maintain rates whether the physicians orders were written in theophylline or aminophylline. With proper nursing inservice, this standard aminophylline program could be successful using this auxiliary flow rate label.     

美罗培南输液在便携式冷冻输液泵中的稳定性

目的 :研究美罗培南输液在输液泵中的稳定性。方法 :选用浓度为 2 0 ,30mg·ml-1的美罗培南输液 ,在两种条件下试验其在 2 4h内的稳定性。用高效液相色谱法测定药物浓度变化。结果 :两种浓度的美罗培南输液在两种条件下 ,2 4h内的浓度值变化率均小于 10 %。结论 :美罗培南输液在本试验的输液泵中 ,可稳定 2 4h。这对临床应用提供了依据。     

Measurement of insulin wastage in five Ontario hospitals

This study was designed to determine the extent of insulin wastage and the extrapolated cost of wastage for Ontario hospitals. The five hospitals in the study were chosen to include differences in patient mix and drug distribution systems. Beginning and ending inventories of all insulin types were taken spanning a six-week period. The quantity of insulin dispensed and wasted during this time period was recorded. Partial vials were measured using a calibrated scale. Wastage was calculated as insulin discarded divided by the amount of insulin used in the time period. Insulin wastage averaged 34.1%. This was equivalent to up to $8,000 a year for the largest hospital surveyed and translates to an estimated cost of $360,000 a year in all Ontario hospitals. Therefore, hospitals should estimate their insulin wastage and seek ways to reduce it. The pharmaceutical industry should be encouraged to develop cost-effective insulin delivery systems.