Cutting costs and reducing waste have been a primary focus for healthcare facilities in the years since the recession hit, prompting many to look into implementing pharmacy process improvement.
US hospitals are now reversing a typical wastage rate of around 5% of dispensed doses of IV medications each month. This was costing an average of more than $53,000. Overall drug and cost losses can be reduced by purchasing of a pre-mixed service that allows economy of scale for smaller hospital pharmacy units, and merger of individual pharmacy departments to a single large and efficient pharmacy servicing one or more hospital Trusts with just a small dispensary serving each Trust site.
Lean pharmacy operation must go hand-in-hand with lean prescribing, that benefits hospital AND community waste minimisation and cost containment. Fewer unnecessary drug prescriptions means less wastage, and a substantially lower environmental burden from waste product flushed down the toilet and excreted drug substance in the sewer.
Everybody wins, or do they? GPs complain about erosion of their prescribing rights and the need for additional hours – and the money that they believe must go with them – to screen prescription requests and eliminate those which are unnecessary. How long does it take to say No?
In hospitals, Trust pharmacists fight to maintain their departments and identify the disadvantages of centralisation while skimming over possible advantages. Claiming an adverse impact of patient care, many Trusts buckle on the fear of litigation and regulatory displeasure. However, the business and environment cases are strong, possibly irresistibly so, and despite the cost of change and perhaps difficult political and professional hurdles, these changes have to come.
The impact of waste pharmaceuticals in the environment is possibly profound. Research must be directed at the effective treatment of hospital and other wastewaters, improved sewage treatments, and front-end improvement in prescription and formulation of pharmaceuticals. Veterinary drug use should not be excluded from this change in practice.
Other approaches, and in particular the nonsense of prohibition of some waste processing procedures for empty syringes that may contain a de minimis concentration of drug residue, are misguided and misplaced. The impact is trivial, immeasurably small and inconsequential when measured against other sources of environmental pollution, or alone. Those facing such restrictions would be wise to Ask for Evidence to support this artificial and possibly mischievous regulatory barrier.