Evaluation of Drug Wastage in the Operating Rooms and Intensive Care Units of a Regional Health Service

Abstract

BACKGROUND: Pharmacological treatments for critical processes in patients need to be initiated as rapidly as possible; for this reason, it is a standard of care to prepare the main anesthesia and emergency drugs in advance. As a result, 20%–50% of the prepared drugs remain unused and are then discarded. Decreasing waste by optimizing drug use is an attractive strategy for meeting both cost containment and environmental sustainability. The primary end point of this study was to measure the actual amount of drug wastage in the operating rooms (ORs) and intensive care units (ICUs) of a Regional Health Service (RHS). The secondary end point was to analyze and estimate the economic implications of this waste for the Health Service and to suggest possible measures to reduce it. METHODS: This prospective observational multicenter study was conducted across 12 hospitals, all of which belong to the same RHS in the north-east of Italy. Data collection took place in March 2018 and included patients admitted to ICUs, emergency areas, and ORs of the participating hospitals. Data concerning drug preparation and administration were collected for all consecutive patients, independent of case types and of whether operations were scheduled or unscheduled. Drug wastage was defined as follows: drugs prepared in ready-to-use syringes but not administered at all and discarded untouched. We then estimated the costs of wasted drugs for a 1-year period using the data from this study and the yearly regional pharmacy orders of drugs provided to the ORs and ICUs. We also performed a sensitivity analysis to validate the robustness of our assumptions and qualitative conclusions. RESULTS: We collected data for a total of 13,078 prepared drug syringes. Drug wastage varied from 7.8% (Urapidil, an alpha-1 antagonist antihypertensive) to 85.7% (epinephrine) of prepared syringes, with an overall mean wastage rate of 38%. The estimated yearly waste was 139,531 syringes, for a total estimated financial cost of €78,060 ($92,569), and an additional quantity of medical waste amounting to 4968 kg per year. The total provider time dedicated to the preparation of unused drugs was predicted to be 1512 working hours per year. CONCLUSIONS: The overall extent of drug wastage in ORs and ICUs is concerning. Interventions aimed at minimizing waste-related costs and improving the environmental sustainability of our practice are paramount. Effort should be put into designing a more efficient workflow that reduces this waste while providing for the emergency availability of these medications in the OR and ICU.

Creating an evidence-based economic model for prefilled parenteral medication delivery in the hospital setting

“…Other studies have revealed that different drugs are associated with different levels of unused drug. 7,10,12 Results indicated that the economic model is sensitive to changes in unused drug levels, with implications for the total cost savings. The primary and sensitivity analyses for both case studies assumed zero waste for PFS; however, it should be acknowledged that there is a potential for discarded doses (e.g., if sterility is broken or if the PFS dose is left unrefrigerated for too long).…”

“…Additionally, the user may select to use reference values that vary by drug and drug dose for vials 12 and a reference value of 3% for PFS. 10 However, unused drug levels associated with conventional method preparation are highly dependent on the drug and type of hospital setting, therefore, reference values should only be used when institution level values are unknown.…”

Sustainable medicines use in clinical practice: A clinical pharmacological view on eco‐pharmaco‐stewardship

“…An estimated 20–50% of drugs drawn up are unused and discarded 30 . A recent multicentre study in Italy of over 13 000 prepared drug syringes found a variation of drug wastage from 7.8% (urapidil) to 85.7% (epinephrine), with an average wastage rate of 38% 31 . Potential strategies to reduce medication waste include the use of prefilled syringes, especially for high acuity, low‐usage rate emergency drugs such as atropine and ephedrine.…”

“…30 A recent multicentre study in Italy of over 13 000 prepared drug syringes found a variation of drug wastage from 7.8% (urapidil) to 85.7% (epinephrine), with an average wastage rate of 38%. 31 Potential strategies to reduce medication waste include the use of prefilled syringes, especially for high acuity, low-usage rate emergency drugs such as atropine and ephedrine. The use of prefilled syringes in prediluted forms with enhanced labelling can also help to reduce the risk of medication errors, as well as variations in drug concentrations.…”

Assessment of the Practice of Storage, Labeling and Usage of Anesthetic Medications in the Operation Theatres of Selected Southern Ethiopian Hospitals: A Multicenter Descriptive Cross-Sectional Study

“…9 Recently, there was huge drug wastage as compared to the standard mainly due to improperly practiced pharmaceutical waste management. 10 Though the overall extent of drug wastage in ORs and ICUs is a concerning issue, 11 substance abuse is the most serious work environment safety issue related to the practice of anesthesiology, having an incidence of 1% per year of practicing. 12 There were also some fatal incidents related to misuse and abuse of propofol among healthcare providers.…”