Evaluation of Drug Wastage in the Operating Rooms and Intensive Care Units of a Regional Health Service.
Anesthetics
/ administration & dosage
Cost Savings
Cost-Benefit Analysis
Drug Compounding
/ economics
Drug Costs
Drug Utilization
/ economics
Emergency Service, Hospital
/ economics
Hospital Costs
Humans
Intensive Care Units
/ economics
Italy
Medical Waste
/ economics
Operating Rooms
/ economics
Prospective Studies
Syringes
/ economics
Time Factors
Workflow
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
01 05 2021
01 05 2021
Historique:
pubmed:
6
3
2021
medline:
18
5
2021
entrez:
5
3
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 33667211
doi: 10.1213/ANE.0000000000005457
pii: 00000539-202105000-00034
doi:
Substances chimiques
Anesthetics
0
Medical Waste
0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1450-1456Informations de copyright
Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the International Anesthesia Research Society.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Rinehardt EK, Sivarajan M. Costs and wastes in anesthesia care. Curr Opin Anaesthesiol. 2012;25:221–225.
Kaniyil S, Krishnadas A, Parathody AK, Ramadas KT. Financial implications of intravenous anesthetic drug wastage in operation room. Anesth Essays Res. 2017;11:304–308.
Mankes RF. Propofol wastage in anesthesia. Anesth Analg. 2012;114:1091–1092.
Van Norman GA, Jackson S. The anesthesiologist and global climate change: an ethical obligation to act. Curr Opin Anaesthesiol. 2020;33:577–583.
Schlünzen L, Simonsen MS, Spangsberg NL, Carlsson P. Cost consciousness among anaesthetic staff. Acta Anaesthesiol Scand. 1999;43:202–205.
Gillerman RG, Browning RA. Drug use inefficiency: a hidden source of wasted health care dollars. Anesth Analg. 2000;91:921–924.
McGain F, White S, Mossenson S, Kayak E, Story D. A survey of anesthesiologists’ views of operating room recycling. Anesth Analg. 2012;114:1049–1054.
Kanji S, Burry L, Williamson DOntario COVID-19 ICU Drug Task Force (Appendix). Therapeutic alternatives and strategies for drug conservation in the intensive care unit during times of drug shortage: a report of the Ontario COVID-19 ICU Drug Task Force. Can J Anaesth. 2020;67:1405–1416.
Deana C, Vetrugno L, Tonizzo A, et al. Drug supply during COVID-19 pandemic: remember not to run with your tank empty. Hospital Pharmacy. Published online June 2, 2020. doi:10.1177/0018578720931749.
doi: 10.1177/0018578720931749
Weinger MB. Drug wastage contributes significantly to the cost of routine anesthesia care. J Clin Anesth. 2001;13:491–497.
Dexter F, Lubarsky DA, Gilbert BC, Thompson C. A method to compare costs of drugs and supplies among anesthesia providers: a simple statistical method to reduce variations in cost due to variations in casemix. Anesthesiology. 1998;88:1350–1356.
Lubarsky DA, Sanderson IC, Gilbert WC, et al. Using an anesthesia information management system as a cost containment tool. Description and validation. Anesthesiology. 1997;86:1161–1169.
Atcheson CL, Spivack J, Williams R, Bryson EO. Preventable drug waste among anesthesia providers: opportunities for efficiency. J Clin Anesth. 2016;30:24–32.
More SR, Dabhade SS, Ghongane BB. Drug audit of intravenous anaesthetic agents in tertiary care hospital. J Clin Diagn Res. 2015;9:FC25–FC28.
Nava-Ocampo AA, Alarcón-Almanza JM, Moyao-García D, Ramírez-Mora JC, Salmerón J. Undocumented drug utilization and drug waste increase costs of pediatric anesthesia care. Fundam Clin Pharmacol. 2004;18:107–112.
Chaudhary K, Garg R, Bhalotra AR, Anand R, Girdhar K. Anesthetic drug wastage in the operation room: a cause for concern. J Anaesthesiol Clin Pharmacol. 2012;28:56–61.
Ryan S, Sherman J. Sustainable anesthesia. Anesth Analg. 2012;114:921–923.
Johnstone RE, Jozefczyk KG. Costs of anesthetic drugs: experiences with a cost education trial. Anesth Analg. 1994;78:766–771.
Watcha MF, White PF. Economics of anesthetic practice. Anesthesiology. 1997;86:1170–1196.
Kirsch MA, Carrithers JA, Ragan RH, Borra HM, Hagan RH. Effects of a low-cost protocol on outcome and cost in a group practice setting. J Clin Anesth. 1998;10:416–424.
Yorioka K, Oie S, Oomaki M, Imamura A, Kamiya A. Particulate and microbial contamination in in-use admixed intravenous infusions. Biol Pharm Bull. 2006;29:2321–2323.