Med O.S.® for Formulary Management Network Result
Optimizing Remifentanil Preparation Saves $114K and Improves Diversion Control
Study Overview
Situation
A large hospital system sought to better align its medication preparation and dispensing practices with financial stewardship initiatives. It further sought to reduce the potential for drug waste and controlled substance diversion.
Business Case & Findings
Controlled substance oversight is a regulatory and safety expectation due to the high risk of patient harm and theft. The hospital system partnered with Bainbridge Health to identify opportunities to optimize controlled substance procurement and preparation practices in order to drive standardization and reduce waste for high-cost medications with significant diversion and harm potential.
Results
Following the Bainbridge Health intervention, the hospital projected $114,223 in annual medication savings through reduced drug waste and achieved a 32% reduction in controlled substance dispensed.
Situation
A large hospital system set a goal to identify and prevent drug waste, specifically targeting cost-savings and controlled substance stewardship opportunities. The system partnered with Bainbridge Health to utilize Med O.S.® to better mine its infusion pump data in order to identify new opportunities. Among the various intervention opportunities, Bainbridge Health identified suboptimal procurement and preparation practices of remifentanil. Remifentanil is a potent and fast-acting opioid used in surgical and critical care settings. It was routinely being prepared in volumes that exceeded actual patient need. Bainbridge Health identified that existing practices could be contributing to unnecessary drug waste, inefficiencies in controlled substance handling, and avoidable spending.
Business Case
- Joint Commission and DEA Standards require that hospitals monitor and promote safe use of opioid medications, including analyzing data to improve prescribing and administration practices1
- The American Society of Health-System Pharmacists (ASHP) highlights the benefits of standardizing I.V. formularies to improve patient safety, simplify EHR workflows for clinicians, and streamline operational processes within pharmacies.2
- Analyzing infusion data has been demonstrated to result in standard concentrations and bag sizes that lead to reduced drug and fluid waste, cost-savings, and streamlined drug procurement and preparation processes.3
Intervention & Impact
Bainbridge Health leveraged its Med O.S.® platform to analyze hospital-specific remifentanil infusion administration patterns. It quickly determined that the hospital was routinely dispensing remifentanil in 50 mL syringes, resulting in meaningful drug waste and increased diversion potential due to availability of an unused controlled substance. This analysis highlighted that:
- On average, 83% of patients required less than 30 mL of remifentanil during their treatment course
- 68% of the medication was being wasted during the administration process, leading to excessive availability and discarding of a high-cost controlled substance
Bainbridge Health recommended standardizing dispense volumes from 50 mL to 30 mL in an effort to reduce high-cost drug waste and potential for diversion, while still maintaining the same clinical quality of patient infusion administration.
By reducing the infusion dispense volume from 50 mL to 30 mL for remifentanil syringe preparations, the hospital system was able to recognize a 32% reduction in total controlled substance dispensed and more than $114,000 in annual savings, driven by reduced drug waste, fewer high-volume syringes prepared, and lower costs associated with controlled substance disposal and documentation.
Reduction in Controlled Substance Dispensed
Projected Annual Savings through Reduced Drug Waste
Related Network Results
Standardizing Norepinephrine Concentrations Reduces Waste, Enhances Safety and Brings Infusions to the Patient Bedside
Fentanyl Infusion Standardization Leads to 25% Reduction in Controlled Substance Dispensing
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Disclaimer
This example is for informational purposes only and should not be relied upon to make specific clinician decisions.
All clinical opportunities identified by Bainbridge Health were evidence-based according to supporting literature and network data. They were also made under the surveillance of the Bainbridge Health Clinical Solutions team, an interdisciplinary group of subject matter experts who provide guidance and oversight.
References
- The Joint Commission (TJC). Leadership standard LD.04.04.05: Policies and procedures based on law and standard practice.
- Blum, K. ASHP’s standardize 4 safety initiative helps pharmacists reduce medication errors. ASHP Intersections. November 12, 2020.
- Forshay CM, Hansen KN, Eckel SF. Using intravenous pump infusion data to optimize continuous infusion concentrations and reduce drug and fluid waste. Am J Health Syst Pharm. 2020 Sep 15;77(18):1497-1503. doi: https://doi.org/10.1093/ajhp/zxaa199