Understanding medication recycling practices in Canadian hospitals.

BACKGROUND: Medication recycling within hospitals has proven financial and possible environmental benefits according to local evaluations done in British Columbia. Despite this, the extent of medication recycling in Canadian hospitals remains unclear in the literature. OBJECTIVE(S): To determine if Canadian hospitals recycle medications, provide an estimate of how much medication is recycled by dosage form, and identify medication recycling barriers through the distribution of a cross-sectional survey. METHODS: A nine-question survey was distributed to 171 hospital pharmacy departments across Canada that consented to complete the survey. The survey identified whether sites recycled unused medications, an estimate of how much is recycled based on dosage form, and barriers to recycling. KEY FINDINGS: Of 62 respondents, the majority indicated they do have medication recycling procedures; however, the frequency of recycling is suboptimal (30-50% of medications are not recycled), and not all medication types are always recycled. Individually packaged oral tablets were most often recycled, and oral liquid medications were least often recycled. Many multi-dose medications were not tamper-proofed. Most respondents selected "sanitization/infection control" and "resource constraint" as reasons for not recycling all medications. CONCLUSIONS: Among respondents, the proportion and type of unused medicines that are recycled varied. For sites that did not respond, this might suggest that medication recycling is not a priority. This could represent a missed opportunity to standardize practices and increase medication recycling in hospitals, both of which could represent a meaningful step towards responsible use of medications and reduction of negative impacts on human health and the environment.

Hiding in Plain Sight: Quantifying Salbutamol and Ipratropium Inhaler Wastage in Hospitals.

Background: Previous studies have found significant inhaler wastage in the inpatient setting, which contributes to unnecessary health care expenditures. Wastage may involve inhalers available in automated dispensing cabinets (ADCs). Objectives: To evaluate whether salbutamol and ipratropium inhalers were unnecessarily withdrawn from ADCs for hospital inpatients. Methods: This cross-sectional study included patients from 16 health care facilities in British Columbia. ADC reports were run for the period August 2021 to January 2022 to identify salbutamol and ipratropium inhalers removed from ADCs. Results: Over the study period, 8.3% (2180/26 324) of salbutamol and ipratropium inhalers were withdrawn from ADCs unnecessarily for the same patient encounter within a 2-day timeframe, and another 1118 (4.2%) represented instances when multiple inhalers were withdrawn for the same patient at the same time. Overall, 12.5% (3298/26 324) of all salbutamol and ipratropium inhalers were withdrawn unnecessarily. The total cost of these inhalers was about $31 600 over the 6-month period. Conclusions: This evaluation revealed considerable wastage of inhalers, leading to wasted expenditures. Other health authorities should conduct similar analyses to determine whether similar problems exist in their settings.

Contexte: De précédentes études ont mis au jour un gaspillage important d'inhalateurs en milieu hospitalier, ce qui contribue à des dépenses de soins de santé inutiles. Ce gaspillage peut comprendre des inhalateurs disponibles dans des cabinet de distribution automatisé (CDA). Objectif: Évaluer si les inhalateurs de salbutamol et d'ipratropium ont été inutilement retirés des CDA pour les patients hospitalisés. Méthodes: Cette étude transversale comprenait des patients provenant de 16 établissements de soins de santé en Colombie-Britannique. Des rapports portant sur les CDA ont été générés pour la période d'août 2021 à janvier 2022 afin de recenser les inhalateurs de salbutamol et d'ipratropium qui ont été retirés des CDA. Résultats: Pendant la période de l'étude, 8,3 % (2180/26 324) des inhalateurs de salbutamol et d'ipratropium ont été inutilement retirés des CDA pour la même rencontre avec le patient dans une fenêtre de 2 jours, et dans le cas de 1118 (4,2 %) inhalateurs, plusieurs inhalateurs ont été retirées en même temps pour un même patient. Dans l'ensemble, 12,5 % (3298/26 324) de tous les inhalateurs de salbutamol et d'ipratropium ont été inutilement retirés. Le coût total de ces inhalateurs s'élevait à environ 31 600 $ sur une période de 6 mois. Conclusions: Cette évaluation a révélé un gaspillage considérable d'inhalateurs, ce qui entraîne des dépenses inutiles. D'autres autorités sanitaires devraient mener des analyses similaires pour savoir si des problèmes similaires se produisent dans leurs établissements.

Recycling unused medications in hospitals is financially viable and good for the environment.

OBJECTIVES: Considerable pharmaceutical waste is generated in hospital settings which can be reduced by recycling of unused medications. We sought to determine the recycling practices as well as quantify the volume and the value of oral solid medications returned from nursing units to the pharmacy departments at three urban hospitals. METHODS: Unused oral solid medications were recycled at three sites and the net financial impact of this practice was calculated (cost recovered - labour costs). The results were extrapolated to all 21 hospitals within the health system. KEY FINDINGS: Recycling medications in 21 hospitals could divert ~461 000 units of medication from the incinerator, with an estimated net value of ~$415 000 per year. CONCLUSIONS: Recycling unused medications could save substantial amounts of money and reduce negative environmental impacts from disposal/incineration.

Evaluation of protocol-guided scheduled basal-nutritional-correction insulin over standard care for vascular surgery patients.

BACKGROUND: Practice guidelines have recommended scheduled basal, nutritional and correction insulin to manage hyperglycemia in the hospital setting. For many decades, however, the primary practice has been sliding scale insulin. OBJECTIVE: To evaluate the efficacy and safety of an institution-specific basal-nutritional-correction insulin preprinted order (BNC-PPO). METHODS: A retrospective, single-centre chart review was conducted on patients admitted to a vascular surgery service to compare inpatient glycemia control before and after implementation of the BNC-PPO. Patients were included if they were aged 19 years or more, admitted between June 2009 and December 2010 (for pre-BNC-PPO) or between April 2011 and August 2012 (for post-BNC-PPO), required insulin before admission for their diabetes mellitus (type 1 or 2) and were prescribed insulin during their admission. RESULTS: For the primary outcome, the mean (±SD) daily blood glucose during hospital stay was 9.83±1.74 mmol/L for the pre-BNC-PPO group and 8.79±1.60 mmol/L for the post-BNC-PPO group (p=0.005). Mean (±SD) severe hyperglycemia episodes per patient per day had decreased in the BNC-PPO group: 1.13±0.73 and 0.80±1.02 for the before and after groups, respectively (p=0.008). Hypoglycemia (blood glucose <2.2 mmol/L and <4 mmol/L) and mild and moderate hyperglycemia episodes were no different between groups. CONCLUSIONS: A structured and proactive approach to inpatient hyperglycemia management appears to be more effective (reduced mean daily blood glucose and severe hyperglycemia episodes) and safer (no increase in hypoglycemia episodes) in maintaining glycemia control in insulin-dependent diabetes patients.