Med O.S.® for Formulary Management Network Result
Fentanyl Infusion Standardization Leads to 25% Reduction in Controlled Substance Dispensing
Study Overview
Situation
A large integrated delivery network (IDN) was interested in evaluating infusion practices for various drugs with a goal of reducing the volume of controlled substances provided to patient care areas.
Findings & Business Case
The Joint Commission Standards and DEA requirements both require hospitals to monitor and promote the safe use of opioid medications, including analyzing data to improve prescribing and administration practices. Bainbridge Health identified opportunities to reduce fentanyl infusion volumes dispensed to care areas, reducing diversion risk and medication waste while improving workflow efficiency.
Results
Bainbridge Health helped optimize fentanyl preparation and procurement practices to reduce the volume dispensed to patient care areas by 25%. This significantly reduced the volume of controlled substances circulating outside the pharmacy.
Situation
A large integrated delivery network (IDN) was interested in evaluating fentanyl infusion practices to reduce the volume of controlled substances dispensed to patient care areas. The pharmacy and medication safety teams were particularly focused on minimizing waste, reducing controlled substance diversion risk, and aligning with internal initiatives to strengthen controlled substance stewardship across all hospital campuses.
Despite formulary controls already in place, hospital leadership engaged Bainbridge Health to further evaluate infusion administration patterns and identify potential interventions to achieve their goal of controlled substance stewardship.
Business Case
- Joint Commission standards and the DEA both require that hospitals monitor and promote safe use of opioid medications, including analyzing data to improve prescribing and administration practices.1
- 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 analyzed drug administration and smart pump infusion data across the health system and found that 41% of patients receiving fentanyl infusions received less than 100 mL of the dispensed 250 mL infusion volume. This highlighted a major opportunity to reduce excess waste and diversion potential of a high-risk opioid medication without impacting patient care.
The team identified interventions to optimize the standard formulation from 2500 mcg in 250 mL (10 mcg/mL) to 1000 mcg in 100 mL (10 mcg/mL). This smaller bag size would not only conserve product but also limit the quantity of controlled substance unnecessarily available in patient care areas. Pharmacy and clinical leadership collaborated to adopt the interventions system-wide. The change was supported with updated infusion pump drug library entries, targeted clinician education, and close monitoring of post-implementation infusion utilization trends.
Following the intervention, the health system dispensed 25% less fentanyl to patient care areas, significantly reducing the volume of this high-risk controlled substance circulating outside the pharmacy.
Less Fentanyl Dispensed
Following the intervention, the health system dispensed 25% less fentanyl to patient care areas, significantly reducing the volume of this high-risk controlled substance circulating outside the pharmacy.
Related Network Results
Optimizing Remifentanil Preparation Saves $114K and Improves Diversion Control
Standardizing Norepinephrine Concentrations Reduces Waste, Enhances Safety and Brings Infusions to the Patient Bedside
Ready to Harness the Full Potential of Your Infusion Data?
Disclaimer
This example is for informational purposes only and should not be relied upon to make specific clinician decisions.
All recommendations made 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