Transcript Cons

Contemplating Kits……..
Jenny Tinson
Production Pharmacist, Southlands Hospital
Hands up…..
• Who packs crash kits?
• Who thinks money could be saved in the
process?
Objective of session
•Share information
•Share ideas
•Improve efficiency of kit process
•Hand-out – for interactive use!
Western Sussex crash box audit
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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
Numbers
Adrenaline 1:10000 10mL
Amiodarone 300mg/10mL
Atropine 3mg/10mL
Calcium chloride 10% 10mL
Sod. Bicarbonate 8.4% 50mL
Used
Expired
400
50
120
30
30
1900
500
500
350
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
Main(or only) or back-up
Adrenaline 1:10000 PFS 10mL
Trust A
Trust B
(adult)
Main
Trust C
(adult)
Main
4
WSHT
Main
9
WSHT
Radiology
Main
6
Trust E
Main
Trust F
Main
6
Trust G
Main
6
Adrenaline 1:1000 PFS 1ml (no needle)
Trust G
Main
8
Trust H
Back-up
Main
7
Trust I
Main
10
1
Adrenaline 1:1000 with needle for anaphylaxis
Trust I
Back-up
3
2
10
6
6
10
1
1
Amiodarone 150mg/3mLs amps
1
2
1
1
1
1
1
1
2
2
2
10
1
1
1
Atropine 1mg in 5ml PFS
2
1
Atropine 600mcg pFS
Calcium chloride 10% PFS
1
3
3
3
2
2
1
5
1
2
1
1
2
Chlorphenamine 10mg /1mL amps
1
1
1
1
Diazemuls 10mg/2mLs amps
10
Glucose 50% mini-jet 50ml
10
1
Hydrocortisone 100mg vial with diluent
1
1
3
Hydrocortisone Sodium Phosphate amp 100mg in 1mL
5
Hydrocortisone Sodium Succinate 100mg vial
(no diluent)
2
Magnesium Sulphate 50% PFS 4ml
1
Magnesium sulphate 50% amp 10mL
1
2
2
1
Naloxone 2mg in 2mL PFS
1
Naloxone 400mcg/1mL ampoules
3
Naloxone 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
Water for Injection 2ml amp
1
10
Naloxone 2mg in 2mL PFS
Sodium chloride 0.9% 10mL amp
2
1
Aminopylline 250mg/10mLs amps
Atropine 3mg in 10mL PFS
6
1
Adenosine 6mg in 2mL
Amiodarone 300mg in 10mL PFS
Main
8
Adrenaline 1 in 1,000 amp 1ml
Adrenaline 1:1000 5mg in 5mL amp
FPH
1
2
1
1
1
1
2
1
10
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 Trust
Pros
Cons
• 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)
• 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 kits
Pros
Cons
• Medical staff know what’s
in box in emergency
• 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?
Thanks for your participation
Aiming to collate data for a wider audience
Kits…don’t we just love them…