Measuring and Reducing Medication Waste in the Emergency Department at an Academic Medical Center

Abstract

Specific Aims: To explore if interventions in pharmacy workflow in the emergency department (ED) of an academic medical center could reduce the rate of medication waste and associated cost. Methods: An analytic, interventional, prospective, pretest-posttest design was used. Data was collected from medication bins within the ED over an eight month period, before and after the intervention. Information recorded included medication name, strength, route of administration, and returned or wasted status. Interventions included suppressing specific automatic medication orders and optimizing the inventory of automated dispensing cabinets (ADCs). Results: 2,878 medications were observed. 2,124 were in the pre-intervention period, and 754 were observed post-intervention. The Medication Wastage Rate pre-intervention was 19.5% (414/2,124) and 14.5% (109/754) post-intervention (p = 0.002). The average Monetary Cost (Low) Per Day was $194.16 (median = 51.1, IQR = 129.7) pre-intervention and $123.62 (median = 30.11, IQR = 62.41) post-intervention (p = 0.097). The average Monetary Cost (High) Per Day was $266.69 (median = 99.05, IQR = 222.84) and $169.99 (median = 66.37, IQR = 89.03) for the pre- and post-intervention period, respectively (p = 0.041). Conclusions: The interventions of suppressing specific automatic medication orders and optimizing the inventory of ADCs reduced the rate of medication waste in a statistically significant fashion (p = 0.002). These interventions reduced the monetary cost associated with this waste according to high estimates in a statistically significant fashion (p = 0.041), but not according to low estimates (p = 0.097).