An automated dispensing cabinet alert influences anesthesia provider medication preparation in a remifentanil waste reduction initiative

Study Objective

To decrease the occurrence of remifentanil waste of 1 mg or more (1 full vial) by 25 % in our surgical division while maintaining satisfaction of 60 % of providers by using a remifentanil mixing workflow.

Design

A time series–design quality improvement initiative targeted preventable remifentanil waste. A period of active interventions, followed by a pause and reinstatement of a system intervention, was used to validate its effectiveness.

Setting

An academic medical center in the US with 1219 inpatient beds, performing 144,418 surgical cases in 2019 and 127,341 surgical cases in 2020, in 148 operating rooms.

Interventions

Individual- and system-level interventions provided education on the issues of preventable waste, access to a remifentanil dose calculator, and an automated dispensing cabinet (ADC) alert to halt wasteful practice.

Measurements

Preventable remifentanil waste was identified as disposing of intravenous infusion bags containing 1 mg or more or 1 full vial or more of unused medication. Data were retrieved from ADC reports. A preimplementation and postimplementation survey of anesthesia providers assessed workflow attitudes, perceptions, and satisfaction surrounding remifentanil mixing.

Main Results

Preventable remifentanil waste (≥1 mg or ≥ 1 full vial) decreased significantly from 22.0 % of cases using remifentanil at baseline to 16.7 % of cases using remifentanil (odds ratio, 0.71; 95 % CI, 0.60–0.84; P < .001) during the final data collection. Individual-level interventions of education, remifentanil dose calculator, and practice champions did not significantly affect waste while unpaired from the system intervention of the ADC alert.

Conclusions

The implementation of an ADC alert reduced preventable remifentanil waste among anesthesia providers.