Discarded intravenous medication in the ICU: the GAME-OVER multicenter prospective observational study

Area of Science:

• Environmental Health
• Healthcare Management
• Clinical Pharmacy

Background:

• Medication waste contributes to the healthcare environmental footprint and impacts ecosystems.
• Data on medication waste specifically within intensive care units (ICUs) are limited, necessitating further investigation.
• The GAME-OVER study addresses this gap by quantifying medication waste in French ICUs.

Purpose of the Study:

• To quantify the percentage of discarded intravenous (IV) medication in the ICU.
• To identify risk factors and primary reasons contributing to medication waste.
• To estimate the associated healthcare costs of discarded IV medications.

Main Methods:

• A prospective, observational, multicenter study (GAME-OVER) conducted in 81 French ICUs from November 2022 to March 2023.
• Inclusion of adult ICU patients who did not object to participation.
• Primary endpoint: percentage of discarded IV medication (discarded volume/total prepared volume). Secondary endpoints: risk factors, reasons for waste, and cost estimation.

Main Results:

• A total of 408.9 L of IV medications were prepared, with 43.8 L (10.7%) discarded.
• Factors like daily ICU admissions/discharges, elective surgery, high SOFA scores, intubation, renal replacement therapy, and BMI were associated with increased waste.
• Ninety percent of waste stemmed from 25 key drugs, with an estimated national annual cost of over 2.7 million euros.

Conclusions:

• Considerable IV medication waste in ICUs leads to significant healthcare costs without clear patient benefit.
• Identified risk factors for waste were largely nonmodifiable.
• Emphasizes the urgent need for sustainable practices in patient care and resource management within ICUs.