title: Medication waste reduction in pediatric pharmacy batch processes.
abstract: OBJECTIVE
  To inform pediatric cart-fill batch scheduling for reductions in pharmaceutical waste using a case study and simulation analysis.
  
  
  METHODS
  A pre and post intervention and simulation analysis was conducted during 3 months at a 205-bed children's center. An algorithm was developed to detect wasted medication based on time-stamped computerized provider order entry information. The algorithm was used to quantify pharmaceutical waste and associated costs for both preintervention (1 batch per day) and postintervention (3 batches per day) schedules. Further, simulation was used to systematically test 108 batch schedules outlining general characteristics that have an impact on the likelihood for waste.
  
  
  RESULTS
  Switching from a 1-batch-per-day to a 3-batch-per-day schedule resulted in a 31.3% decrease in pharmaceutical waste (28.7% to 19.7%) and annual cost savings of $183,380. Simulation results demonstrate how increasing batch frequency facilitates a more just-in-time process that reduces waste. The most substantial gains are realized by shifting from a schedule of 1 batch per day to at least 2 batches per day. The simulation exhibits how waste reduction is also achievable by avoiding batch preparation during daily time periods where medication administration or medication discontinuations are frequent. Last, the simulation was used to show how reducing batch preparation time per batch provides some, albeit minimal, opportunity to decrease waste.
  
  
  CONCLUSIONS
  The case study and simulation analysis demonstrate characteristics of batch scheduling that may support pediatric pharmacy managers in redesign toward minimizing pharmaceutical waste.
authors.affiliation: Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland ; Operations Integration, Johns Hopkins Health System, Baltimore, Maryland.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Toerper
authors.affiliation: Pediatric Division, Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland ; Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Veltri
authors.affiliation: Operations Integration, Johns Hopkins Health System, Baltimore, Maryland.
authors.forename: Eric
authors.initials: E
authors.lastname: Hamrock
authors.affiliation: Pediatric Division, Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Mollenkopf
authors.affiliation: Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Kristen
authors.initials: K
authors.lastname: Holt
authors.affiliation: Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland ; Operations Integration, Johns Hopkins Health System, Baltimore, Maryland.
authors.forename: Scott
authors.initials: S
authors.lastname: Levin
keywords: computer simulation; cost control; hospital; medical waste; pharmacy service