Hospitals Implement Innovative Strategies to Reduce Controlled Substance Waste and Improve Patient Care

Hospitals Implement Innovative Strategies to Reduce Controlled Substance Waste and Improve Patient Care

Hospitals across the country are actively seeking new approaches to minimize drug waste, specifically focusing on controlled substances. The primary goal is to ensure patients receive accurate dosages while simultaneously decreasing lost revenue and mitigating the risk of drug diversion. Recent insights suggest that by understanding the drivers of waste and implementing improvements, pharmacy teams can significantly reduce both documentation time and costs for nursing and pharmacy departments.

Recognizing a consistent pattern of controlled substance waste in their busier areas, University Health Truman Medical Center (UHTMC) undertook a comprehensive waste analysis to gain deeper insights into prevailing waste practices within their facility. Led by Emily Mueller, PharmD, UHTMC’s Pharmacy Automation, Informatics, and Supply Chain Manager, the team extended considerable efforts, spending up to four hours each day to reconcile controlled substance waste. Even with the assistance of diversion management software, the inefficiencies persisted. However, UHTMC made a remarkable discovery—by optimizing product sizes, they could potentially eliminate approximately 11,000 waste transactions related to fentanyl annually.

Mueller explained, “After analyzing our waste data, specifically in high-traffic areas such as the emergency department, surgery, and ICUs, we observed the extent of waste from each drug vial. It dawned on us that over 60% of our fentanyl orders were for a 50-microgram dose, despite utilizing 100-microgram vials. We were wasting a significant amount, which had to be rectified.”

To address the issue, UHTMC established an interdisciplinary controlled substance diversion prevention committee. Drawing from the findings of their waste analysis, which estimated that nursing staff spent 466 hours annually on fentanyl waste (requiring two nurses for each event), the committee saw an opportunity for substantial time and cost savings. They decided to transition to Simplist® ready-to-administer prefilled syringes for fentanyl with a 50 mcg per 1 mL presentation.

Through this strategic product switch, which offered secure, tamper-evident packaging and aligned with provider practice patterns, UHTMC witnessed a reduction in waste events, along with a decrease in nursing and pharmacy documentation time for controlled substance waste.

Mueller elaborated, “This improvement not only reduced risks in numerous transactions, especially in busy settings, but it also gave us back valuable time. We were able to streamline the nursing workflow for waste disposal, saving our nurses a substantial amount of time. Additionally, in the pharmacy, fentanyl discrepancies reduced significantly. We hardly needed to send emails to correct records with providers. Overall, it has revolutionized the administration and management of controlled substance waste.”

While tackling the challenge of reducing controlled substance waste and minimizing drug diversion opportunities may appear daunting, the rewards outweigh the efforts. Mueller encourages other healthcare facilities to conduct their own waste analysis to identify areas for waste reduction and consider implementing products that align better with clinical practices.

“By adopting optimal-sized controlled substances, hospitals can enhance diversion prevention and alleviate the workload for nursing and pharmacy staff,” said Mueller. “It simplifies tracking and resolution processes, enabling more efficient management of diversion risks. If you seek methods to improve your diversion tracking, this is a step in the right direction.”


Q: What is the primary objective of hospitals in reducing drug waste?
A: Hospitals aim to decrease drug waste, particularly for controlled substances, to ensure proper dosing, mitigate revenue loss, and reduce the risk of drug diversion.

Q: How did University Health Truman Medical Center (UHTMC) address controlled substance waste?
A: UHTMC conducted a waste analysis and optimized product sizes, leading to the elimination of an estimated 11,000 waste transactions involving fentanyl per year.

Q: What benefits did UHTMC observe after implementing changes?
A: UHTMC witnessed a reduction in waste events, nursing and pharmacy documentation time, and fentanyl discrepancies. This also resulted in risk reduction and time-saving for busy healthcare settings.

Q: What recommendation does Emily Mueller, PharmD, offer to other hospitals?
A: Mueller suggests that other hospitals conduct waste analyses to identify opportunities for waste reduction. Implementing products that align with clinical practice patterns can lead to improved diversion prevention and streamlined processes.

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