April 15, 2010

Children’s Hospital pharmacy changes improve efficiency

Children’s Hospital pharmacy changes improve efficiency

Changes in pharmacy processes at the Monroe Carell Jr. Children's Hospital at Vanderbilt are on track to realize substantial annual savings.

Last summer, the pharmacy began looking at ways they could decrease medication waste. To do so, all medication waste from pediatric inpatient units was collected in six large bins over a seven-day period.

The bulk of the wasted medication was returned to the pharmacy unused, and was duplicated, discontinued, changed or was for a patient already discharged. The majority of the doses could not be reused and were thrown away.

Two pharmacy residents from the University of Tennessee tracked each kind of medication that was collected in the bins, and assigned a level from one to three depending on the cost of labor and medication expense.

The estimated annual cost of the collected waste (drug and labor cost) was $2.3 million, nearly $900,000 of which was attributed to medications in oral liquid syringes. Pharmacy staff took an “all hands on deck” approach to determining how to reduce the medication waste. They found that the main culprit was the process for filling medication orders.

Due to the ongoing medication needs of patients, certain scheduled medications (oral and IVs) were prepared 19 hours ahead of their scheduled administration time.

“We found that this actually created more work due to preparing them so far ahead of their administration time,” said Jenny Jastrzembski, assistant director of the Children's Hospital Pharmacy.

The pharmacy team previously pre-prepared nearly 800 oral syringes at a time. But then the team found it made more sense to split preparation in two batches. The first batch of approximately 500 oral syringes is prepared at noon, and a second batch of 300 oral syringes is prepared in the evening.

Not only has the change saved money and decreased waste, it has also improved patient safety.

“Theoretically there was a reduction of risk for patients because the change reduced the chance that the patient might receive an outdated dose,” said Amy Potts, clinical manager of Pharmacy Services at Children's Hospital.

The annual savings for the reduction of waste for the oral syringe medication will total nearly $445,000 at the close of the fiscal year, which is a 50 percent cost reduction.

“We could not have been successful without staff taking ownership of this project,” said Elizabeth Humphreys, director of the Children's Hospital Pharmacy. “It was a major change in workflow culture. We would also like to acknowledge UT Doctor of Pharmacy candidates Connie Barker and Joseph Pandit, and technician coordinator Linda Bonner for their data collection efforts.”