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Critical analysis of common canister programs: a review of cross-functional considerations and health system
Trent Larson1, Ravindra Gudavalli, Dean Prater
1Banner Health , Mesa, AZ , USA.
Abstract:
Respiratory inhalers constitute a large percentage of hospital pharmacy expenditures. Metered-dose inhaler (MDI) canisters usually contain enough medication to last 2 to 4 weeks, while the average hospital stay for acute hospitalizations of respiratory illnesses is only 4-5 days. Hospital pharmacies are often unable to operationalize relabeling of inhalers at discharge to meet regulatory requirements. This dilemma produces drug wastage. The common canister (CC) approach is a method some hospitals implemented in an effort to minimize the costs associated with this issue. The CC program uses a shared inhaler, an individual one-way valve holding chamber, and a cleaning protocol. This approach has been the subject of considerable controversy. Proponents of the CC approach reported considerable cost savings to their institutions. Opponents of the CC approach are not convinced the benefits outweigh even a minimal risk of cross-contamination since adherence to protocols for hand washing and disinfection of the MDI device cannot be guaranteed to be 100% (pathogens from contaminated devices can enter the respiratory tract through inhalation). Other cost containment strategies, such as unit dose nebulizers, may be useful to realize similar reductions in pharmacy drug costs while minimizing the risks of nosocomial infections and their associated medical costs. The CC strategy may be appropriate for some hospital pharmacies that face budget constraints, but a full evaluation of the risks, benefits, and potential costs should guide those who make hospital policy decisions.
Insights
Hospital pharmacies face inhaler waste due to discharge timing. The common canister (CC) approach offers cost savings but raises cross-contamination concerns, necessitating careful risk-benefit evaluation.
Area of Science:
- Health Economics
- Hospital Pharmacy Management
- Infectious Disease Prevention
Background:
- Respiratory inhalers represent a significant hospital pharmacy expenditure.
- Discharge timing often leads to medication wastage from metered-dose inhaler (MDI) canisters.
- Hospital pharmacies face challenges in relabeling MDIs for regulatory compliance at discharge.
Purpose of the Study:
- To evaluate the common canister (CC) approach for reducing MDI costs in hospitals.
- To analyze the controversy surrounding the CC approach, including cost savings versus cross-contamination risks.
- To compare the CC approach with alternative cost-containment strategies like unit dose nebulizers.
Main Methods:
- Review of the common canister (CC) program implementation and outcomes.
- Analysis of reported cost savings by proponents of the CC approach.
- Examination of concerns regarding cross-contamination and adherence to disinfection protocols.
Main Results:
- Proponents report significant cost savings through the CC program.
- Opponents highlight the risk of cross-contamination due to imperfect disinfection adherence.
- Alternative strategies like unit dose nebulizers are suggested to reduce costs and infection risks.
Conclusions:
- The CC strategy may be suitable for budget-constrained hospital pharmacies.
- A comprehensive evaluation of risks, benefits, and costs is crucial before policy adoption.
- Balancing cost containment with patient safety (minimizing nosocomial infections) is paramount.
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