The DOI matches its Crossref record; 6 of the 7 references it cites were found in a registry or an index.
Drug Use Inefficiency: A Hidden Source of Wasted Health Care Dollars
Abstract
UNLABELLED: A potential area for departmental savings is to minimize inefficient use of pharmaceuticals. We recorded drug waste data for multiple drugs for a fiscal year and surveyed providers' knowledge of departmental drug waste. Six large-cost or large-volume use drugs were chosen for study: thiopental, succinylcholine, rocuronium, atracurium, midazolam, and propofol. Amounts administered to patients were collected for one year by using a computerized anesthesia record keeper. Total drug distributed was the number of vials restocked by pharmacy for the year. An efficiency index, the percent administered to patients, was calculated for each drug. Drug administration to 25,481 patients was analyzed. Drug use efficiency indices were: atracurium 29%; thiopental, 31%; succinylcholine, 33%; propofol, 49%; midazolam, 53%; rocuronium, 61%. The total cost of unadministered study drugs was $165,667, 26% of the expenditure for all drugs. Most dollars wasted were for propofol, $80,863, and thiopental, $32,839. The reason most cited for drug waste was the disposal of full, or partially full, syringes. Drug wastage represents a significant portion of the entire anesthesia drug budget. Waste reduction strategies should allow a portion of the "avoidable" waste to be reduced. IMPLICATIONS: Unadministered drug amounts were measured for six study drugs over one fiscal year and found to be significant; the cost of unadministered drugs totaled $165,667. The reason most cited for waste was disposal of full, or partially full, syringes.
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“Nevertheless, performing TIVA instead of inhalational anesthesia has environmental costs of its own because of the increased disposable plastic waste, higher propofol consumption, and consecutively increased wastage rate.70,71”
From A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint (2023) · cites this paper as [71]
In the citing paper
“Nevertheless, the life-cycle carbon emission is lower than in inhalation anesthesia.”
From A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint (2023) · cites this paper as [71]
Citations
Cites
Postoperative Infections Traced to Contamination of an Intravenous Anesthetic, Propofol
Bennett, S., McNeil, M. M., Bland, L. A., Arduino, M. J., Villarino, M. E., Perrotta, D. M., Burwen, D. R., Welbel, S. F., Pegues, D. A., Stroud, L., et al. (1995) · New England Journal of Medicine · doi:10.1056/nejm199507203330303 · Cited by 510
The Successful Implementation of Pharmaceutical Practice Guidelines
Lubarsky, D. A., Glass, P. S. A., Ginsberg, B., Dear, G. D. L., Dentz, M. E., Gan, T. J., Sanderson, I. C., Mythen, M. G., Malthouse-Dufore, S., Pressley, C. C., et al. (1997) · Anesthesiology · doi:10.1097/00000542-199705000-00019 · Cited by 142
Kuehnert, M. J., Webb, R. M., Jochimsen, E. M., Hancock, G. A., Arduino, M. J., Hand, S., Currier, M. M., & Jarvis, W. R. (1997) · Anesthesia & Analgesia · doi:10.1097/00000539-199708000-00031 · Cited by 52
Long-Term Pharmaceutical Cost Reduction Using a Data Management System
McNitt, J. D., Bode, E. T., & Nelson, R. E. (1998) · Anesthesia & Analgesia · doi:10.1097/00000539-199810000-00017 · Cited by 15
The Successful Implementation of Pharmaceutical Practice Guidelines? Far From Convincing!
Bailey, P. L., & Egan, T. D. (1997) · Anesthesiology · doi:10.1097/00000542-199712000-00042 · Cited by 5
Pharmaceutical Practice Guidelines
Fisher, D. M., & Kelley, S. D. (1998) · Anesthesiology · doi:10.1097/00000542-199807000-00041 · Cited by 4
Cited by
Sorted by citations
Life cycle greenhouse gas emissions of anesthetic drugs
Sherman, J., Le, C., Lamers, V., & Eckelman, M. (2012) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e31824f6940 · Cited by 496
Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update
Varughese, S., & Raza, A. (2021) · Anesthesia & Analgesia · doi:10.1213/ane.0000000000005504 · Cited by 206
Propofol Wastage in Anesthesia
Mankes, R. F. (2012) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e31824ea491 · Cited by 140
European Society of Anaesthesiology and Intensive Care consensus document on sustainability
González‐Pizarro, P., Brazzi, L., Koch, S., Trinks, A., Muret, J. C., Weiland, N. H. S., Jovanovic, G., Cortegiani, A., Fernandes, T., Kranke, P., et al. (2024) · European Journal of Anaesthesiology · doi:10.1097/eja.0000000000001942 · Cited by 92
Anesthesia information management systems: a review of functionality and installation considerations
Ehrenfeld, J. M., & Rehman, M. (2010) · Journal of Clinical Monitoring and Computing · doi:10.1007/s10877-010-9256-y · Cited by 82
Metadata
- Authors
- Gillerman, R. G., & Browning, R. A.
- Affiliations
- Rhode Island Hospital (US)
- Corresponding author
- Gillerman, Richard G.
- Venue
- Anesthesia & Analgesia
- Published
- 2000-10
- Volume
- 91
- Issue
- 4
- Pages
- 921-924
- ISSN
- 0003-2999 (ISSN-L)
- OpenAlex
- W2081055529
- Cited by
- 103
- References
- 7
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 9 · 2023: 6 · 2022: 6 · 2021: 6 · 2020: 4 · 2019: 6 · 2018: 3 · 2017: 3 · 2016: 6 · 2015: 4 · 2014: 2 · 2013: 10 · 2012: 5
- FWCI
- 5.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesia & Analgesia (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Anesthesia and Sedative Agents
- Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
- Keywords
- pharmaceutical waste, anaesthetic drugs, propofol, thiopental, succinylcholine, rocuronium, atracurium, midazolam, syringe disposal, health care costs, efficiency index
- MeSH terms
- Rocuronium, Androstanols, Anesthesia Department, Hospital, Anesthetics, Atracurium, Budgets, Neuromuscular Nondepolarizing Agents, Drug Utilization, Efficiency, Hospital Records, Humans, Hypnotics and Sedatives, Medical Waste, Midazolam, Neuromuscular Depolarizing Agents, Pharmacy Service, Hospital, Succinylcholine, Syringes, Thiopental, Propofol, Medical Records Systems, Computerized, Drug Costs, Health Care Costs, Anesthetics, Intravenous
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