The Economics of a Pharmacy-Based Central Intravenous Additive Service for Paediatric Patients

Abstract

This study was designed to compare the costs of a pharmacy-based Central Intravenous Additive Service (CIVAS) with those of traditional ward-based preparation of intravenous doses for a paediatric population. Labour costs were derived from timings of preparation of individual doses in both the pharmacy and ward by an independent observer. The use of disposables and diluents was recorded and their acquisition costs apportioned to the cost of each dose prepared. Data were collected from 20 CIVAS sessions (501 doses) and 26 ward-based sessions (30 doses). In addition, the costs avoided by the use of part vials in CIVAS was calculated. This was derived from a total of 50 CIVAS sessions. Labour, disposable and diluent costs were significantly lower for CIVAS compared with ward-based preparation (p < 0.001). The ratio of costs per dose [in 1994 pounds sterling] between ward and pharmacy was 2.35:1 (2.51 pounds:1.07 pounds). Sensitivity analysis of the best and worst staff mixes in both locations ranged from 2.3:1 to 4.0:1, always in favour of CIVAS. There were considerable costs avoided in CIVAS from the multiple use of vials; the estimated annual sum derived from the study was 44,000 pounds. In addition, CIVAS was less vulnerable to unanticipated interruptions in work flow than ward-based preparation. CIVAS for children was more economical than traditional ward-based preparation, because of a cost-minimisation effect. Sensitivity analysis showed that these advantages were maintained over a full range of skill mixes. Additionally, significant savings accrued from the multiple use of vials in CIVAS.

Ethnographic study of incidence and severity of intravenous drug errors

“…Centralised preparation of intravenous drugs is common in the United States16 but not in Europe, apart from in specialised areas such as oncology 17. The evidence for centralised services is currently weak, and it is unclear whether they are cost effective or improve the quality of the service 18 – 21. An alternative strategy would be to purchase ready prepared intravenous drugs from pharmaceutical companies.…”

Causes of intravenous medication errors: an ethnographic study

“…26 Other changes to reduce medication preparation errors include the central preparation of IV medication, 25 but the evidence base for the success of such a service is currently weak. [27][28][29][30] Design issues such as ampoules which look similar 31 32 and the complex design of infusion pumps 33 have previously been recognised as risk factors. We have also shown that the failure to handle complex drug vial presentations correctly resulted in medication errors.…”

Systematic evaluation of errors occurring during the preparation of intravenous medication

“…Third, there may be practical and cost advantages to the centralized preparation of medications. [34][35][36] Although our data suggest that this strategy may reduce the number of errors, it would not signifi- cantly reduce errors of larger magnitude (Table 2). Remote preparation of medications may not be ideal, because delays in the availability of medications may result in adverse outcomes.…”