Contemplating Kits…….. Jenny Tinson Production Pharmacist, Southlands Hospital.
-
Upload
daniel-montgomery -
Category
Documents
-
view
225 -
download
1
Transcript of Contemplating Kits…….. Jenny Tinson Production Pharmacist, Southlands Hospital.
Objective of session
•Share information•Share ideas•Improve efficiency of kit process
•Hand-out – for interactive use!
Western Sussex crash box audit
• 2 years of data• 190 kits for 600 bed Trust (W&S only)• 225 recorded uses of kits• 514 kits returned for replenishment (expired)• Average kit shelf life 5.5 months• £4,000 expenditure on ‘used’ PFS• £21,000 expenditure on ‘expired’ PFS
NumbersUsed Expired
Adrenaline 1:10000 10mL 400 1900Amiodarone 300mg/10mL 50 500Atropine 3mg/10mL 120 500Calcium chloride 10% 10mL 30 350Sod. Bicarbonate 8.4% 50mL 30 200
That’s £1.8m per year on expired drugs if extrapolated to 170 acute Trusts in England
Wider kit survey
• Jim Armstrong asked for similar figures nationally
• Response from 11 Trusts inc. WSHT• Huge variety of kit contents• No-one had looked at use/expiry figures
Drug Trust A Trust B (adult)
Trust C (adult)
WSHT WSHT Radiology
Trust E Trust F Trust G Trust G Trust H Trust I Trust I FPH
Main(or only) or back-up Main Main Main Main Main Main Main Main Back-up Main Main Back-up Main
Adrenaline 1:10000 PFS 10mL 4 9 6 6 6 8 7 10 8 6Adrenaline 1:1000 PFS 1ml (no needle) 1 1 Adrenaline 1:1000 with needle for anaphylaxis 3 2 Adrenaline 1 in 1,000 amp 1ml 10 2Adrenaline 1:1000 5mg in 5mL amp 1 Adenosine 6mg in 2mL 6 6 Aminopylline 250mg/10mLs amps 10 Amiodarone 300mg in 10mL PFS 1 1 1 2 1 1 1 2 2 2Amiodarone 150mg/3mLs amps 10 Atropine 3mg in 10mL PFS 1 1 1 1 1 1 2 1 Atropine 1mg in 5ml PFS 1 3 3 3Atropine 600mcg pFS 2 Calcium chloride 10% PFS 1 1 2 1 1 1 2 2 1 Chlorphenamine 10mg /1mL amps 1
5 1
Diazemuls 10mg/2mLs amps 10 10 Glucose 50% mini-jet 50ml 1 1 1 Hydrocortisone 100mg vial with diluent 3 Hydrocortisone Sodium Phosphate amp 100mg in 1mL 5 Hydrocortisone Sodium Succinate 100mg vial (no diluent)
2 Magnesium Sulphate 50% PFS 4ml 1 1 2 2 1Magnesium sulphate 50% amp 10mL 10 Naloxone 2mg in 2mL PFS 1 Naloxone 2mg in 2mL PFS 1 Naloxone 400mcg/1mL ampoules 3Naloxone 400mcg/1mL MJ 2 Potassium Chloride 40mmol in 0.9% NaCl 100mls bag 2 Salbutamol nebs 5mg in 2.5mL 5 Sodium bicarbonate 8.4% 50mL Minijet 1 1 1 1 1 2 1
Sodium chloride 0.9% 10mL amp 2 10
Water for Injection 2ml amp 1
Not to mention Anaphylactic kits, Paediatric Crash Kits.…….
What can we do with this data?
• Consider re-use of near-expired drugs? How could this be done? Please fill in your sheets now…..
Re-use of short-dated drugs from within own TrustPros• Can make an assumption
about storage temperatures and conditions
• Minimal (if any)transit temperature fluctuations
• All stock ‘owned’ by Trust• Reasonably easy to keep audit
trails of drug purchase and use• Minimises waste for
incineration• Saves ££ (QIPP target)
Cons• Does the Trust have a
location in which to re-use the drugs?
• Robust expiry date checks needed, frequently
What other pros and cons did you have?
Re-use of short-dated drugs from external Trusts
Pros• All stock ‘owned’ by Trust• Reasonably easy to keep
audit trails of drug purchase and use
• Saves ££ (QIPP target)
Anything else?
Cons• Cannot make an assumption
about storage temperatures and conditions
• Transit temperature fluctuations between sites
• Robust expiry date checks needed, frequently (by them)
• Managing process – do customers remove drugs they want before returning kits to us?
• How manage stock finances on JAC?
• Wholesale dealing rules?
National format for kitsPros
• Medical staff know what’s in box in emergency
Cons
• Supply problems impact all packing units at same time (2 main PFS suppliers)
Strive to have a nationally agreed adult/paed cardiac arrest and anaphylactic kits?
Would any national body e.g. Resuscitation Council take this forwards?
Is this worth pursuing?