Hospitals nationwide are looking for innovative ways to decrease drug waste, particularly for controlled substances. An effective solution would ensure patients receive the correct dose, decrease lost revenue and mitigate risk of drug diversion.1 To effectively reduce controlled substance waste and associated diversion risk, pharmacy teams must first understand what is driving waste and how efforts to improve can reduce both nursing and pharmacy documentation time as well as costs.
After noticing a pattern of inconsistent controlled substance wasting in busier areas, University Health Truman Medical Center (UHTMC) decided to conduct a detailed waste analysis to get a better understanding of common waste practices that were occurring in the hospital. Emily Mueller, PharmD, Pharmacy Automation, Informatics and Supply Chain Manager at UHTMC, said her team spent up to four hours per day reconciling controlled substance waste – even after deploying diversion management software to assist with its monitoring and management efforts. UHTMC discovered they could eliminate an estimated 11,000 waste transactions per year involving fentanyl by optimizing the size of products to meet their hospital’s needs.
“After analyzing our waste data, particularly in busy areas like the emergency department, surgery and ICUs, we were able to look into our orders and see how much was wasted from each drug vial,” she said. “That offered us a real opportunity, because over 60% of our orders for fentanyl were for a 50-microgram dose – and since we were using the 100-microgram vials, we found we were wasting a lot. It was something we knew we had to fix.”
UHTMC convened an interdisciplinary controlled substance diversion prevention committee to help with optimizing controlled substance dispensing and use. After seeing the results of their waste analysis, which estimated 466 hours of nursing time expended to waste fentanyl annually (with two nurses required for each wasting event), the committee saw it had an opportunity to enact significant time and cost savings by switching to Simplist® ready-to-administer prefilled syringes for fentanyl in a 50 mcg per 1 mL presentation (PLEASE CLICK BOXED WARNING BELOW FOR FULL PRESCRIBING INFORMATION AND COMPLETE BOXED WARNING).
By using a product with secure, tamper-evident packaging and sizing to improve alignment of the stocked presentation with provider practice patterns, UHTMC has seen a reduction in wasting events, as well as in the nursing and pharmacy time required to complete the controlled substance waste documentation process.
“This helped us reduce risk on a lot of transactions, especially in busy settings,” said Mueller. “But it’s also given us back a lot of our time. We were able to optimize the nursing workflow for wasting, saving our nurses a great deal of time. And, in the pharmacy, we’ve already seen a reduction in fentanyl discrepancies. We haven’t had to send out as many emails to track down the providers to correct the record. It makes the administration and management of controlled substance waste much easier.”
Finding ways to reduce controlled substance waste – and, as a result, drug-diversion opportunities – can seem daunting. However, the payoff, Mueller said, is more than worth it. She recommends that other hospitals undergo their own waste analysis to understand how they can maximize waste reduction opportunities, including the implementation of products that better align with clinical practice.
“Adopting optimal-sized controlled substances can lead to better diversion prevention, as well as reduce work burden for nursing and pharmacy colleagues,” she said. “It makes our tracking and resolution much easier. If you are looking for ways to better track your diversion risks, this is a step in the right direction.”
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