Cost impact of using patients' own multidose medications in hospital

The use of patients' own medications may allow minimization of drug wastage and costs. However, the cost impact of this practice, taking into account the time that pharmacy personnel spend on verification, is unknown.

To determine the cost impact of using patients' own multidose medications within a surgical population, relative to the cost of routine dispensing; to describe the prescribing of multidose medications with regard to type, prevalence, quantity, and formulary status; and to determine the percentage of medications suitable for use after verification.

In this prospective, consecutive, time-and-motion case series, admission orders for patients newly admitted to 6 surgical units were screened to identify patients' own multidose medications that required verification. The total time required for all verification-related activities was captured. Data were collected over 3 weeks in early 2011.

Of the 250 patients admitted, 51 (20.4%) had a prescription for one of their own multidose medications. Verification was completed for 67 (79%) of 85 prescribed items, of which 61 (91%) were deemed suitable for use. Thirty-five different medication types were identified. Of the 85 prescribed medications, 57 (67%) were on formulary. The most common routes of administration for these 85 prescribed items were inhalation (56 [66%]), nasal (9 [11%]), and ophthalmic (8 [9%]). The average cost ± standard deviation was $24.54 ± $32.33 per multi-dose item. The average time required for verification was 10.5 ± 6.7 min per patient (4.8 ± 3.3 min per medication). The cost impact was calculated as the difference between the drug cost with routine hospital dispensing and the cost of verifying home medications, where a positive value indicated a lower cost with verification of home medications (i.e., a saving for the hospital). The average cost impact was $40.05 ± $42.60 per patient (p < 0.001 by 1-sample t test) ($18.85 ± $15.42 per medication). A total cost saving of $1601.85 was realized.

Using patients' own multidose medications instead of routine dispensing resulted in a cost saving of 74%, including labour costs for verification by the pharmacist.