Pharmacy performance evaluation: A single-center assessment of drug waste and mitigation strategies

This case study evaluates 2 years of sterile medication compounding at a pediatric oncology institution to identify opportunities for increased operational efficiencies that reduce medication waste. The primary outcome for this case study was the rate of fully returned sterile compounded doses relative to the total number of dispensed sterile compounded doses during the study period, calculated as the percentage of returned drugs. Secondary outcomes included categorization of the most frequently returned therapeutic classes and dispense codes.

Major goals of this case study included the following: (1) quantify the proportion of doses returned relative to the total prepared through the intravenous workflow management system (IVWMS), (2) compare year-to-year differences in return rates, (3) characterize the therapeutic classes most frequently associated with returned doses, and (4) assess the impact of operational interventions on return trends over time. Medication returns were reviewed over time to evaluate the impact of operational interventions to reduce waste. Select interventions included updates to batch inclusions/times, changing the default start time from midnight to 8 AM, addition of cefazolin premix, restriction of intravenous fluid auto-dispensing, and updated extended stability parameters for cyclophosphamide and cyclosporine. Across the 2-year period, the overall medication return rate decreased from 9.68% to 7.31% despite an increase in total doses prepared. A reduction in returns was seen for continuous infusion, continuous infusion premix, and intravenous piggyback (IVPB) mixtures. Central pharmacy returns declined from 10.5% to 8%.

Implementation of targeted operational changes led to a reduction in returned intravenous compounded medications, demonstrating the effectiveness of these efforts in reducing waste. Across the study period, anti-infective agents and continuous infusion mixtures consistently stood as top contributors to drug returns, which reflects our unique population of pediatric oncology patients.