(Management Case Study) Plugging the Drain — Supply Chain and Sterile Product Operations Partnering to Minimize IV Waste

Purpose: Compound sterile product (CSP) waste is an overlooked area in some inpatient facilities as a focus for cost reduction measure. Focus, locally and nationally, is primarily on medication use, purchasing contracts and reimbursement to drive cost savings. Noticing large returns to our facility led to the implementation of a rolling annual IV waste study to quantify this loss and discuss solutions. In this session, we will outline our data collection, evaluation and financial analysis of results and finalization of operational changes implemented over the past three years of CSP waste studies conducted at our facility.

Methods: An annual IV waste audit is conducted to determine how much money the department spent on expired or returned IV products. During the 2-week audit all expired, admixed IV products that could not be re-distributed were placed in a designated area in our central pharmacy and compounding area. Drug name, strength, quantity, and location were recorded on a and total waste numbers and associated costs were calculated and annualized. Using the 80:20 rule, the top 10 IV drugs wasted by cost were also identified and a summary of the audit was presented to the pharmacy staff and a workgroup of pertinent stakeholders was created. This group workshopped potential solutions to decrease waste including revising batching techniques, matching product preparation closer to administration times for short stability items, improving communication around transition of care and review of literature for extended stability data. During subsequent audits, the preceding year’s top 10 are analyzed to see if long term impact was achieved.

Results: Based on operational changes, a reduction in IV waste of $539,078 dollars over a 3-year period (5% of total compounded sterile product spend over the same time period was achieved). In addition to the financial improvements, the post-audit workflows lead to operational efficiencies gained for our IV space including but not limited to: optimizing PAR levels of decentralized IV compounded products, leveraging more mini-bag plus workflows, utilizing advanced prep reporting, and improved communication from the clinical teams to the IV room which has assisted us beyond the scope of this project.

Conclusion: A 2-week audit for expired, admixed IV products that are not able to be re-distributed had significant cost savings to the academic flagship hospital in a 24-hospital health system. Review and targeted projects to the top ten wasted products has proven to be a successful approach to decrease waste and cost of compounded sterile products. In addition, cost savings from saved technician and pharmacist time for compounding, product validation, and delivery was not evaluated but should be considered a benefit to this ongoing review process