Anti-infective Waste in a Pediatric Institution: Pinpointing Problems in the Process

Abstract

Purpose: At Children’s Hospital Colorado (CHCO), there are approximately 40 000 inpatient anti-infective orders every year resulting over 100 000 dispenses. Significant quantities of anti-infectives are wasted, incurring roughly $100 000 in waste annually. Identifying areas for improvement will result in cost savings and ameliorate the impact of drug shortages. Summary: This descriptive report discusses the reasons for anti-infective waste at a free-standing, quaternary-care, pediatric hospital. The anti-infectives with the highest cost in waste ($) included meropenem ($38 084), micafungin ($21 690), amphotericin B liposome ($15 913). An internal audit of CHCO anti-infective waste revealed that drugs are wasted for the following reasons: patient discharge, medication order discontinuation or change, and misplaced doses. Conclusion: The CHCO Antimicrobial Stewardship Program and the Pharmacy have proposed 4 process improvement measures that will target anti-infective waste to reduce pharmaceutical waste and hospital costs. These measures may be applicable to other drug classes that likely suffer from a similar proportion of waste.

Regulations on Green Pharmacy in European Countries – A Comparative Study

“…In Romania, there is also a need to implement appropriate practices to prevent or minimize the elimination of pharmaceuticals in the environment, not only through recycling or better water removal [22,36], but also through law enforcement and thorough implementation of appropriate guidelines and procedures for the waste management of medicines generated by the population, following the Spanish, French or Hungarian model [13,44,48,51]. Taking into account the significant cost of pharmaceutical waste management activities [30,31,33,35,40,44,55] and the impact of economic development on the success of implementing high performance environmental policies [5,19,56], we consider that new regulations on the management of pharmaceutical wastes produced in household can be adopted and implemented in Romania. In order for this to actually happen, there is a need for political will in reducing the environmental costs of economic growth, the participation of competent authorities, i.e.…”

“…Pharmacies and drugstores, although with legal responsibility, are not fully committed to that process, and in practice there is no coherent system of collection and disposal of unused and expired medicines originated from patients, as some authors already noticed [7,50,51]. Pharmaceutical enterprises and pharmaceutical professionals could have many ways to contribute to environmental protection, as shown by FIP [29], the European Commission [15], authors from different countries [6,33,45,49,51,55,57] or some professional organizations [21,26,40,41]. However, for this purpose, specific training is needed [8,10,15,29,45,49,51,57]; the Romanian College of Pharmacists could be inspired by professional initiatives from other countries and could implement specific projects for the continuous education of pharmacists in the field of environmental protection.…”

“…Furthermore, research has been conducted in different countries emphasizing possible solutions for a better pharmaceutical waste management system, such as: creating well organized pharmaceutical waste classification systems, educating population for a rational use of medicines, implementing adequate collection schemes, organizing safe storage areas and providing sufficient financial support for pharmaceutical waste disposal. All scholars agree that there is of utmost importance to have specific regulations in this field, educational programs for healthcare professionals as well as for patients [6,7,10,30,33,38,45,49,51,57]. Also, a study in the United States reveals that a correct standardization of doses for each hospitalized patient and a better timing for the administration of medicines could significantly reduce the quantity of pharmaceutical waste in hospitals [33].…”

“…All scholars agree that there is of utmost importance to have specific regulations in this field, educational programs for healthcare professionals as well as for patients [6,7,10,30,33,38,45,49,51,57]. Also, a study in the United States reveals that a correct standardization of doses for each hospitalized patient and a better timing for the administration of medicines could significantly reduce the quantity of pharmaceutical waste in hospitals [33]. Romanian authors have emphasized the environmental contamination with medicines in Romania, the need for better regulations and better practices of pharmaceutical waste management [7,9,22,36,43,[50][51][52][53].…”

Reductions in Medication Wastage and Costs in a Pediatric Intensive Care Unit by Changing the Order Entry System

“…In addition, meropenem, micafungin, and amphotericin B liposomal were among the antibiotics with the highest wasted costs. To reduce this drug waste and hospital costs, they proposed four process improvement measures [10]. Based on the results of a study regarding pediatric anesthesia care for determining the cost of the used drugs without documentation, the uncontrolled availability of drugs in floor stocks and their undocumented use were important causes of increasing drug costs and wastage [11].…”