Development of optimized adult epidural infusion preparations to reduce waste and improve operational efficiency

Despite national recommendations to standardize infusion concentrations, there is minimal guidance on institution-specific strategies and outcomes related to epidural infusion concentration standardization and optimization. The purpose of this project is to identify the optimal compounded preparation for use in select adult epidural infusions and assess the impact on drug and fluid utilization and cost savings if the designated preparation is adopted.

A previously validated tool, the VERB (vial, exchange, rate, and bag) analysis, was applied to epidural infusion pump administration data to identify preparations optimized for efficient supply and resource utilization at a large academic medical center.

Weighing all components of the VERB analysis, the preferred preparation of hydromorphone and bupivacaine for the hospital site was hydromorphone (10 µg/mL) and bupivacaine (0.125%) in 50 mL of 0.9% sodium chloride injection (2,500 µg of hydromorphone per epidural). The preferred preparation of fentanyl and bupivacaine was fentanyl (2 µg/mL) and bupivacaine (0.0625%) in 50 mL of 0.9% sodium chloride injection (100 µg of fentanyl per epidural). Both recommendations are different from the currently utilized preparations at the study site.

Analyzing historic drug administration data using the novel 4-step VERB analysis identified optimized drug preparations and fluid bag sizes for the most-prescribed epidural drug combinations at the hospital study site.