Reducing expenses and improving workflow continues to be a top priority for hospitals. As the new accountable care-focused landscape unfolds, hospital pharmacies are challenged to improve drug supply and reduce drug waste while enhancing the care of patients.
Since all hospital administrators must focus on the bottom line, executives must consider new ways to improve efficiencies in how drugs are distributed and administrated. One way to achieve this is by streamlining how injectable drugs are prepared by clinicians at the patient's bedside for immediate delivery.
Enter Providence Hospital. The 349-bed facility in Mobile, Ala., cares for more than 15,000 inpatients and 150,000 outpatients each year, and improving workflow was a daily challenge for hospital pharmacists and clinicians. Under the hospital's former drug administration and reconstitution system, pharmacists and pharmacy technicians prepared and reconstituted batches of injectable drugs in the pharmacy's IV room. The components were often limited to 50mL or 100mL IV bags and 20mm diameter drug vials requiring the use of a needle and syringe for 13mm diameter drug vials. It was challenging for technicians to prepare exact doses and portions of the drugs often were left unused. Additionally, pharmacists were tasked with complying with new United States Pharmacopeia regulations regarding immediate use procedures for drug doses.
USP Chapter <797> Pharmaceutical Compounding: Sterile Preparations notes that, once dispensed from a hospital pharmacy, drug doses cannot be returned to the pharmacy, even if they are unused. If they are returned to be reused, the required documentation, dating and storage nullify the advantage of return. Each year at Providence Hospital and other hospitals nationwide, a significant amount of drug product was thrown away if drug doses were unused or if a patient's prescription changed or ended. There were immense cost implications, not just in the actual drug waste but also in the pharmacy technicians' time. Each prescription change forced technicians and pharmacists to spend more time preparing replacement doses. The extra time and workload intensified for the pharmacy technicians, and with additional workflow the chance of errors increased. The hospital was forced to dispose of substantial quantities of costly drug products, and a great number of IV bags had to be ordered to safeguard that the hospital had duplicate inventory on hand. In combination with the drug waste, these issues created significant expenses year after year.
An additional challenge for intravenously administered drugs was the technology used for reconstituting and delivering doses of injectable drugs at the patient bedside. IV bags are used to administer everything from saline drips to complicated compound drug treatments. In the past, several different proprietary systems that were not compatible with all types of IV bags were used to facilitate the transfer and reconstitution of lyophilized drug products from vials to solution-filled IV bags. This meant that pharmacists and nurses had to spend time searching for the correct pairing of specialized vial and specialized bag each time an IV treatment was prepared. In addition, all 13mm diameter vials were reconstituted and transferred using a needle and syringe, exposing the hospital staff to potential needle sticks.
To overcome many of these hurdles, in 2013, Providence Hospital implemented the Vial2Bag® system, a needleless reconstitution system for compounded sterile preparations. Vial2Bag can assist in meeting the requirements of USP 797 for immediate use application and can help optimize pharmacy cleanroom time, reduce drug and fluid waste, and assist in standardizing admixture systems for nursing. This flexibility means that Vial2Bag is able to work with both 13mm and 20mm diameter vials and all IV bags used throughout the hospital. Hospital staff and clinicians are able to prepare, reconstitute and administer critical drug doses to the patient immediately on the patient floors and at the bedside, ensuring quick delivery of needed medication. This streamlined process cut down on the number of IV bags that need to be routed from the hospital pharmacy to patient floors and reduced the risk of drug waste while providing flexibility in IV bag sourcing and inventory reduction. It also made it easy for clinicians to administer drug doses to patients in urgent care situations directly at the bedside without waiting for the pharmacy. As an example, delicate compounds such as the antibiotic Vancomycin are no longer mixed and prepared well in advance of administration as they were in the past.
Nurses can prepare critical drips at the bedside in real-time, eliminating the wait for a pharmacy technician to mix and transport the IV. The new system helped eliminate more than 25 percent of preparation work in the pharmacy's IV room, significantly improving pharmacist workflows within the hospital. This also assisted with the hospital's patient safety initiatives by reducing the time required to administer medication doses in critical care situations.
The methods implemented at Providence Hospital to reduce drug waste can be used by other hospitals, clinics, and outpatient and long-term care facilities. There are several best practices healthcare facilities can follow in order to reduce the expense of drug waste and extra workflow, minimize inventory and maintain supply in response to bag shortages from a single vendor:
- First, consider all available technology options in order to find a drug delivery solution that effectively meets your facility's needs.
- Second, provide training for clinicians on how to reconstitute drugs for IV solutions using needle-free admixture systems, reducing unnecessary dependency on the pharmacy.
- Finally, review USP guidelines to ensure hospital personnel are in compliance with safety standards established for preparing and delivering drug products.
In just over a year since deployment, Providence Hospital has experienced firsthand the benefits advanced drug reconstitution and administration technologies can have on managing drug supply and reducing unused drug products. The hospital estimates its switch to the Vial2Bag needle-free IV admixture system will save more than $160,000 per year in reduced labor and product costs. The ease of access to critical medications helps Providence Hospital clinicians minimize intervention times and improve patient outcomes and has been an effective solution for the hospital's specialized needs and focus on patient quality and safety.
Gino Agnelly is a director of pharmacy at Providence Hospital (part of St. Louis-based Ascension Health) in Mobile, Ala. Agnelly has more than 25 years of hospital pharmacy practice experience ranging from IV room Technician through to direction of multiple pharmacy operations in six states. Vial2Bag® is a registered trademark of Medimop Medical Projects Ltd., a subsidiary of West Pharmaceutical Services, Inc.