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P50 Identification of wastage of medicines in a paediatric intensive care unit
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  1. Malgorzata Tylek,
  2. Jessica Payne
  1. Evelina London Childrens Hospital

Abstract

Background and Aim The world faces many obstacles in achieving access to affordable, safe and high-quality medicines. Shortages of stock, rising prices, falsified medicines entering the chain makes it an ethical issue to minimalize wastage of medicines.1

Each year the NHS loses £300 million on wastage in prescribed medicines as ‘a by-product’ of the everyday activities in the NHS.2 Currently, there aren’t any national programmes aimed at addressing this issue.3 This data was collected in a primary care setting, however practice in secondary care indicates that medicine wastage also exists there. The aim of this study was to identify the degree of medicines wastage in a large paediatric intensive care unit (PICU).

Objectives

  • Identify the amount of wastage generated by incorrect storage of intravenous (IV) and oral liquid medicines on the PICU.

  • Identify the amount of wastage generated by not recording the expiry date on IV and oral liquid medicines on the PICU.

  • Identify the cost implication of the above.

Method Inclusion Criteria

  • Medicines stored in a location not in accordance with the recommendation of the Summary of Product Characteristic (SmPC).

  • Liquid medicines stored correctly, but no expiry date or date opened recorded on the product as per the recommended standard in the trusts’ medicine policy.4

Data Collection

The audit was conducted from September to November 2022 on a tertiary PICU encompassing 24 beds. Medications which were stored incorrectly as per the inclusion criteria were recorded and analysed together with finance information (retrieved from the British National Formulary) in Microsoft Excel©. As per the trusts’ standard operating procedure (SOP) all oral liquid medications have a three months expiry date once opened unless the expiry is shorter as stated on the bottle.4

Results Over a two-month period 61 items were identified as wasted due to incorrect storage or no recording of expiry date. This included 14 vials of intravenous solutions and 47 bottles of oral liquids. There were 15 items stored in the incorrect location and 46 items with no recorded opening date. The total wastage cost during the audited period was £3103 (as per NHS indicative price) which included:

  • IV solutions wastage: £785

  • Oral liquid medicines wastage: £2318

Conclusions The audit showed that wastage of IV and oral liquid medicines is a significant problem on PICU. The biggest contributor to the total wastage cost were oral liquid medicines and this was predominantly caused by the opening date not being recorded. Liquid medications are commonly used throughout paediatrics and there is often the need for more expensive unlicensed liquids. The collected data shows that there is potential for large cost saving by providing education and training to prevent this avoidable wastage. Regular data collection on all medicines wastage in the unit will be implemented as a part of service improvement.

Since the audit took place, the data was used for teaching during Medicine Safety Week for the nurses in February 2023.

References

  1. World Health Organisation. Access to medicines and health products [Internet]. 2023 https://www.who.int/our-work/access-to-medicines-and-health-products (Accessed 23 June 2023).

  2. GOV.UK. Action on medicines wastage and improving medicines use [Internet]. 2011 https://www.gov.uk/government/news/action-on-medicine-wastage-and-improving-medicine-use (Accessed 29 June 2023).

  3. NHS England. Pharmaceutical Waste Reduction in the NHS, NHS England Report [Internet]. 2015 https://www.england.nhs.uk/wp-content/uploads/2015/06/pharmaceutical-waste-reduction.pdf (Accessed 29 June 2023).

  4. Operational Policy: Medicines Policy. Guy’s & St Thomas’ NHS Foundation Trust Medicines Policy Version 5. September 2021.

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