Monitoring waste in an intravenous admixture program

Abstract

A method for collecting and analyzing data on i.v. admixture waste is described, and examples of the use of these data to reduce waste are presented. In 1984, a pharmacy department serving 580 hospital beds projected annual expense for waste of i.v. products to be nearly $30,000. Five major changes were implemented to reduce waste. Modification of expiration dating policies for cefoxitin and tobramycin substantially reduced waste. After an operating room pharmacy satellite was opened, decreased waste of dobutamine, dopamine, nitroglycerin, and nitroprusside was estimated to save $1000 per year. Changing times of batch processing of i.v. admixtures resulted in cost savings that were not significantly different for three-month periods before and after the change. The method of identifying small-volume injections (SVIs) to be manufactured was improved, and SVIs of expensive drugs were prepared every 12, instead of 24, hours; these changes resulted in reduction of one technician full-time equivalent but little change in the percentage or cost of SVIs wasted. Decentralized pharmacists were asked to order certain items on an as-needed basis; this did not affect costs or waste. From 1984 to 1985, total costs associated with waste decreased an estimated $11,000, or 27.5%. This department's attempt to change i.v. admixture procedures based on timely data has resulted in substantial reductions in the cost of waste.