Hertig John, Jarrell Kaitlyn, Arora Prachi, Nwabueze Jonell, Moureaud Charlotte, Degnan Daniel D, Trujillo Tate
Butler University, Indianapolis, IN, USA.
Indiana University Health, Indianapolis, IN, USA.
Hosp Pharm. 2021 Oct;56(5):584-591. doi: 10.1177/0018578720931754. Epub 2020 Jun 2.
There are significant costs associated with proper controlled substance disposal, management, and regulatory compliance. Given the high abuse potential of fentanyl, hydromorphone, and morphine it is imperative that (1) product waste is minimized; and (2) waste procedures are followed to ensure safe disposal. Research is needed to better understand the financial and workforce impacts of drug waste on inpatient hospital units. The primary objective of this study was to quantify the waste associated with administering fentanyl, hydromorphone, and morphine via the intravenous push route. Two categories of waste were evaluated: (1) the quantity (mg/µg) of drug disposed; and (2) workforce time associated with the waste disposal process. A workflow time study design, a sub-set of continuous direct observation time motion studies, was employed to achieve the research objectives. A data collection tool was developed to capture medication type, waste amount, activity time stamps, total time, and number of interruptions at two separate study sites. Descriptive statistics were conducted on all the data measures. The number of assessments, total values, and mean values were reported for each drug (fentanyl, hydromorphone, and morphine) separately as well as grouped data. A total of 669 distinct waste observations meeting inclusion criteria were collected during a study period of 15 days. In total, 207 mg of hydromorphone and 17 962.50 µg of fentanyl were wasted during this study. Nursing staff time associated with the wasting process totaled 50 990 seconds (849.83 minutes or 14.16 hours). A combined waste (loss) of approximately $1605.39 was associated with controlled substance wasting. The cost per dose wasted in this study was found to be $2.40 for all medications. When a yearly extrapolation model was applied to the four study units, the total combined product and workforce waste cost was $35 425. There are financially significant costs associated with wasting both the product and the valuable time of a skilled workforce. Optimizing product size, taking special note to match product availability with common practice use, would reduce the associated financial burden on our health-systems nationwide.
妥善处理管制药品、进行管理并遵守相关规定会产生巨大成本。鉴于芬太尼、氢吗啡酮和吗啡的滥用可能性很高，必须做到：（1）尽量减少药品浪费；（2）遵循废物处理程序以确保安全处置。需要开展研究，以更好地了解药品浪费对住院科室在财务和人力方面的影响。本研究的主要目的是量化通过静脉推注途径使用芬太尼、氢吗啡酮和吗啡所产生的浪费。评估了两类浪费：（1）废弃药品的数量（毫克/微克）；（2）与废物处理过程相关的人力时间。采用工作流程时间研究设计（连续直接观察时间动作研究的一个子集）来实现研究目标。开发了一种数据收集工具，以获取两个不同研究地点的药物类型、废物量、活动时间戳、总时间和中断次数。对所有数据指标进行了描述性统计。分别报告了每种药物（芬太尼、氢吗啡酮和吗啡）以及汇总数据的评估次数、总值和平均值。在为期15天的研究期间，共收集到669条符合纳入标准的不同废物观察数据。在本研究中，总共浪费了207毫克氢吗啡酮和17962.50微克芬太尼。与浪费过程相关的护理人员时间总计50990秒（849.83分钟或14.16小时）。管制药品浪费造成的综合浪费（损失）约为1605.39美元。本研究中发现，所有药物每浪费一剂的成本为2.40美元。当将年度外推模型应用于四个研究科室时，产品和人力的总综合浪费成本为35425美元。浪费产品和熟练劳动力的宝贵时间在财务上会产生重大成本。优化产品规格，特别注意使产品供应与常见使用情况相匹配，将减轻全国医疗系统的相关财务负担。
