An automated dispensing cabinet alert influences anesthesia provider medication preparation in a remifentanil waste reduction initiative

• Published in: Journal of clinical anesthesia 2024-12, Vol.99, p.111611, Article 111611
• Main Authors: Wooten, Laura R., Sadlowsky, Matthew J., Oberhansley, Jeffrey M., Matulis, John C., Brinkman, Nathan J., Schroeder, Darrel R.
• Format: Article
• Language: English
• Subjects: Academic Medical Centers - organization & administration; Analgesics, Opioid - administration & dosage; Anesthesia; Anesthetics, Intravenous - administration & dosage; Anesthetics, Intravenous - adverse effects; Automation; Change management; Clinical decision support; Cost analysis; Cost control; Drug Compounding; Health care costs; Humans; Intervention; Medical personnel; Medication Errors - prevention & control; Medication Errors - statistics & numerical data; Narcotics; Operating Rooms - organization & administration; Pharmaceutical technology; Pharmacy; Quality Improvement; Remifentanil; Remifentanil - administration & dosage; Remifentanil - adverse effects; Statistical analysis; Waste management; Workflow
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2024.111611

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