Dealing with IV waste in hospitals?

[gnuel]

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Not sure if it's just in California, but here unless we log the Lot# and expiration date of every item used in the IV process (alcohol swabs, syringes, the stock bottle, etc), any IVPB made in the hood will have to be discarded within 24 hours. This creates a lot of waste from meds that are discontinued or changed...I'm curious to see how other hospitals deal with this? Any creative ideas?

 

[smercer]

Not sure if it's just in California, but here unless we log the Lot# and expiration date of every item used in the IV process (alcohol swabs, syringes, the stock bottle, etc), any IVPB made in the hood will have to be discarded within 24 hours. This creates a lot of waste from meds that are discontinued or changed...I'm curious to see how other hospitals deal with this? Any creative ideas?

We finally got around to increasing the expiration dates on our piggybacks that can last for longer than 24hrs. This helps a ton with the Vanco waste. Probably the biggest waste I see is with KCl drips and Bicarb drips. Most the issues seem to arise from times getting off and not being updated or patients being transfered and the meds not being sent with the patient.

Also most meds that will last longer than 24hrs will need to be refrigerated, thus this becomes an issue for storing meds on the floor after they are dispensed.

 

[gnuel]

We finally got around to increasing the expiration dates on our piggybacks that can last for longer than 24hrs. This helps a ton with the Vanco waste. Probably the biggest waste I see is with KCl drips and Bicarb drips. Most the issues seem to arise from times getting off and not being updated or patients being transfered and the meds not being sent with the patient.

Also most meds that will last longer than 24hrs will need to be refrigerated, thus this becomes an issue for storing meds on the floor after they are dispensed.

Do you guys record the lot and exp of everything used in making the IVs?

 

[smercer]

Do you guys record the lot and exp of everything used in making the IVs?

We only record that for dilutions. Of course we are not in Cali, so I guess the laws may be different.

 

[PRmed]

Not sure if it's just in California, but here unless we log the Lot# and expiration date of every item used in the IV process (alcohol swabs, syringes, the stock bottle, etc), any IVPB made in the hood will have to be discarded within 24 hours. This creates a lot of waste from meds that are discontinued or changed...I'm curious to see how other hospitals deal with this? Any creative ideas?

WOW, you guys even log the alcohol swabs and syringes?? That's incredible. Is this just for IV's that you bulk batch or single IV's? Do you use a paper log or online? We only keep a record of the Lot# and expiration date when batching.

At our hospital we usually use stability information found in the package insert, micromedex or lexi-comp. As long as the stability is available from a reliable source, then we use that for the expiration date (example KCl large volumes are 7 days as well as vanco and quite a few others.) Since we are a small hospital we also hold off on mixing short stability/expensive IV's until a few hours before they are to be administered. Not sure if that would work at your location.

Does your hospital ever send anything with the NS/D5W mini-bags that the nurses spike with the vial? This has saved us quite a bit especially since you just credit the unused vial and use it for another patient.

 

[gnuel]

No, we currently do not log everything as we do not have the manpower to do so...thus, everything that is returned, we just toss since it's past 24 hrs. There is technology out there to log everything, but it is very expensive. There was a recall on alcohol pads a few years ago so I guess that's the reasoning for the board of pharmacy to set that strict requirement.

Yes, we do use quite a few of those, but we make a lot in the hood as well.