title: Drug use inefficiency: a hidden source of wasted health care dollars.
abstract: A potential area for departmental savings is to minimize inefficient use of pharmaceuticals. We recorded drug waste data for multiple drugs for a fiscal year and surveyed providers' knowledge of departmental drug waste. Six large-cost or large-volume use drugs were chosen for study: thiopental, succinylcholine, rocuronium, atracurium, midazolam, and propofol. Amounts administered to patients were collected for one year by using a computerized anesthesia record keeper. Total drug distributed was the number of vials restocked by pharmacy for the year. An efficiency index, the percent administered to patients, was calculated for each drug. Drug administration to 25,481 patients was analyzed. Drug use efficiency indices were: atracurium 29%; thiopental, 31%; succinylcholine, 33%; propofol, 49%; midazolam, 53%; rocuronium, 61%. The total cost of unadministered study drugs was $165,667, 26% of the expenditure for all drugs. Most dollars wasted were for propofol, $80,863, and thiopental, $32,839. The reason most cited for drug waste was the disposal of full, or partially full, syringes. Drug wastage represents a significant portion of the entire anesthesia drug budget. Waste reduction strategies should allow a portion of the "avoidable" waste to be reduced.
  
  
  CONCLUSIONS
  Unadministered drug amounts were measured for six study drugs over one fiscal year and found to be significant; the cost of unadministered drugs totaled $165,667. The reason most cited for waste was disposal of full, or partially full, syringes.
authors.affiliation: Department of Anesthesia, Rhode Island Hospital, Providence, Rhode Island 02903, USA. rgillerman@lifespan.org
authors.forename: R G
authors.initials: RG
authors.lastname: Gillerman
authors.forename: R A
authors.initials: RA
authors.lastname: Browning
mesh_terms: D000732:Androstanols / Q000008:administration & dosage / Q000191:economics; D000761:Anesthesia Department, Hospital / Q000191:economics / Q000458:organization & administration; D000777:Anesthetics / Q000008:administration & dosage / Q000191:economics*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000191:economics; D001279:Atracurium / Q000008:administration & dosage / Q000191:economics; D002017:Budgets; D016527:Drug Costs; D004363:Drug Utilization / Q000191:economics; D004526:Efficiency; D017048:Health Care Costs; D006753:Hospital Records; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000191:economics; D016347:Medical Records Systems, Computerized; D008506:Medical Waste / Q000191:economics; D008874:Midazolam / Q000008:administration & dosage / Q000191:economics; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage / Q000191:economics; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000191:economics; D010607:Pharmacy Service, Hospital; D015742:Propofol / Q000008:administration & dosage / Q000191:economics; D000077123:Rocuronium; D013390:Succinylcholine / Q000008:administration & dosage / Q000191:economics; D013594:Syringes / Q000191:economics; D013874:Thiopental / Q000008:administration & dosage / Q000191:economics
chemical_list: D000732:Androstanols; D000777:Anesthetics; D018686:Anesthetics, Intravenous; D006993:Hypnotics and Sedatives; D008506:Medical Waste; D009467:Neuromuscular Depolarizing Agents; D003473:Neuromuscular Nondepolarizing Agents; D001279:Atracurium; D013390:Succinylcholine; D013874:Thiopental; D008874:Midazolam; D000077123:Rocuronium; D015742:Propofol