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An automated dispensing cabinet alert influences anesthesia provider medication preparation in a remifentanil waste reduction initiative
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An automated dispensing cabinet alert influences anesthesia provider medication preparation in a remifentanil waste reduction initiative
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Journal Article
An automated dispensing cabinet alert influences anesthesia provider medication preparation in a remifentanil waste reduction initiative
2024
Overview
To decrease the occurrence of remifentanil waste of 1 mg or more (1 full vial) by 25 % in our surgical division while maintaining satisfaction of 60 % of providers by using a remifentanil mixing workflow.
A time series–design quality improvement initiative targeted preventable remifentanil waste. A period of active interventions, followed by a pause and reinstatement of a system intervention, was used to validate its effectiveness.
An academic medical center in the US with 1219 inpatient beds, performing 144,418 surgical cases in 2019 and 127,341 surgical cases in 2020, in 148 operating rooms.
Individual- and system-level interventions provided education on the issues of preventable waste, access to a remifentanil dose calculator, and an automated dispensing cabinet (ADC) alert to halt wasteful practice.
Preventable remifentanil waste was identified as disposing of intravenous infusion bags containing 1 mg or more or 1 full vial or more of unused medication. Data were retrieved from ADC reports. A preimplementation and postimplementation survey of anesthesia providers assessed workflow attitudes, perceptions, and satisfaction surrounding remifentanil mixing.
Preventable remifentanil waste (≥1 mg or ≥ 1 full vial) decreased significantly from 22.0 % of cases using remifentanil at baseline to 16.7 % of cases using remifentanil (odds ratio, 0.71; 95 % CI, 0.60–0.84; P < .001) during the final data collection. Individual-level interventions of education, remifentanil dose calculator, and practice champions did not significantly affect waste while unpaired from the system intervention of the ADC alert.
The implementation of an ADC alert reduced preventable remifentanil waste among anesthesia providers.
••Remifentanil waste has environmental, financial, and safety implications.••A system intervention influenced waste more than did individual interventions.••Pausing an active automated dispensing cabinet alert validated the intervention.••Interventions decreased preventable remifentanil waste by 24 %.
Publisher
Elsevier Inc,Elsevier Limited
Subject
Academic Medical Centers - organization & administration
/ Analgesics, Opioid - administration & dosage
/ Anesthetics, Intravenous - administration & dosage
/ Anesthetics, Intravenous - adverse effects
/ Humans
/ Medication Errors - prevention & control
/ Medication Errors - statistics & numerical data
/ Operating Rooms - organization & administration
/ Pharmacy
/ Remifentanil - administration & dosage
/ Remifentanil - adverse effects
/ Workflow
