Transcript OPrac 5

RETURN UNUSED MEDICINES FOR
DISPOSAL PROGRAMME IN PUTRAJAYA
HOSPITAL –
A 3 MONTH PRELIMINARY REPORT.
CPA-MPS 2007,
PARK ROYAL,
KUALA LUMPUR.
SUBRAMANIAM THANIMALAI
CHING MIN WEI
HALIMATUS SA’DIAH AHMAD
Contents
1
BACKGROUND
2
OBJECTIVES
3
METHODOLOGY
4
RESULTS & DISCUSSION
5
CONCLUSION
BACKGROUND
 The value of unused medicines throughout the world
was immense :
Saudi Arabia & Gulf countries 2002 US150 million,
Texas, USA 2003: US 26,000
Puy-de-Dome,France 2001 : 87456FF.
Hisham S. et al 2002, Kevin Garey et al 2004
 There is little published information on why unused
medicines are returned to the pharmacies.
S.Braybrook et al. The Pharmaceutical Journal (TPJ)
Sept.1999
 The waste of medicines represents the end-point of
sub-optimal drug use and is an anti-thesis of good
medicines management.
Adam Mackridge et al TPJ January 2004
AIM OF STUDY
To obtain preliminary data on unused
medicines, reasons for nonconsumption, storage and disposal
practices of unused medication among
Putrajaya Hospital patients.
OBJECTIVE
1
2
To assess public
awareness on
storage
conditions and
disposal.
To identify types
of unused drugs
stored at home
and reasons for
nonconsumption.
3
To analyze the
costs of the
unused drugs.
METHODOLOGY
Single-centered,
Prospective,
observational
study.
Posters, Banners
displayed and
flyers were
distributed.
Public who return medications
voluntarily were asked to fill an
investigator - assisted questionnaire.
Patients were given token of
appreciation for their participation.
EXCLUSION CRITERIA
 Drugs returned from the ward.
 Expired drugs from hospitals, clinics
and other institutions.
 Drugs returned from non governmental
sources and unidentifiable/
unquantifiable drugs were accepted but
not included in the analysis.
DATA ANALYSIS
Drugs returned were assessed in terms
of type, source, quantity, expiry,
reasons for returning and ownership.
Cost of the drugs were accounted
according to the Putrajaya Hospital
purchase price at the end of 2006.
Data gathered were analysed using
Microsoft Excel.
ASSUMPTIONS
All answers to the questionnaire were
assumed to be a true reflection of the
respondents practice.
Voluntary participation, without
coercion from any healthcare personnel.
COST OF THE PROJECT
ESTIMATED TOTAL COST OF THE PROJECT
RM 2670
RM 620
POSTERS
&
BANNERS
Token of
Appreciation
- Courtesy of
Hospital
Management
Estimated
Disposal
Cost
RM2000
BROCHURES
&
FLIERS
RM 50
General Information
The result reflects the data collected in
the first 3 month of the study
(Nov 2006 – Jan 2007).
A total of 81 patients responded to the
program and 145 types of medications
were returned for various reasons.
Age Group of the Respondents
Classification of Respondents According To Age
Respondents age
varies from the age
11-80 years old.
10%
65% of the
respondents were the
age group of 21-60*.
Mean age group of the
highest respondents
were 56 years.
•This correlates with the M’sian
population( UNDP Data 2001)
7%
4%
11 – 20 years
14%
21 – 30 years
31 – 40 years
41 – 50 years
51 – 60 years
61 – 70 years
25%
21%
19%
71 - 80 years
GENDER OF RESPONDENTS
Classification of Respondents According To Gender
Female
52%
Male
48%
Male
Female
 There were almost equal amount of males and
females who returned unused medicines.
ETHNIC DISTRIBUTION
Ethnics Classification of Respodents
80
70.4
70
60
50
Percentage of
40
respondent
19.8
30
8.6
20
1.2
10
0
Malay
Chinese
Indian
Race
Others
EDUCATION LEVEL OF RESPONDENTS
Education Level of Respondents
14%
37%
49%
Primary
Secondary
University
Medication Storage Conditions
Drug Storage Areas
31.37
35
26.47
30
25
Percentage
20
of
Respondents
15
(%)
10
13.73
6.86
5.88
6.86
Medication Cupboard / Bedroom Refrigerator Handbag
Box
Drawer
Kitchen
8.82
5
0
Other
Places
RESULTS - Disposal Methods
Preferred Method of Disposal of Unused Medications
57.18
60
50
40
Percentage
of
30
Respondents
(% )
20
24.49
8.16
4.08
10
1.02
2.04
3.06
0
Rubbish
Bin
Toilet
Bury
Drain
Method of Disposal
Sink
Return To
Pharmacy
Others
Discussion - Disposal Methods
Majority (68%) of the disposal methods
were non-environmental friendly way
(rubbish bin, toilet, sink and drain).
90% of the respondents claimed to be
aware of the environment risks related
to the environmentally unfriendly
method of medicines disposal.
72% of the knowledgeable respondents
disposed it via the methods.
RESULTS - RETURNED REASON
Respondent's Reason For Returning Medicines
8%
26%
23%
1%
4%
17%
Excessive Stock
Change Medicines
Other's Medication
Others
21%
Expired
Did Not Take Medicines
Not Sure
ADVERSE DRUG REACTIONS
NO
OFFENDING DRUG
ADVERSE EVENT
1 Valsartan 80mg &
Hydrochlorothiazide12.5mg (CoDiovan)
Dizziness and headache.
2 Cetirizine 10mg (Xetec)
Non-stop sneezing and nose blockage due to Xetec.
No complaints on previous brand Adezio (Cetirizine
10mg).
3 Rabeprazole 20mg (Pariet)
Dizziness and abdominal pain after second dose.
Developed skin eruption (pimple-like) on eyelids,
mouth area and nose along with watery eyes and
headache with third dose.
4 Mecobalamin 500mcg (Methycobal)
Pain in the eyes.
5 Betahistine 16mg (Betaserc)
Numbness in the face and mouth along with swollen
eyes.
6 Losartan 100mg &
Hydrochlorothiazide 25mg (Hyzaar)
Dizziness.
DRUGS RETURNED - TOP 5 CLASSES
Top Five Classes Of Medications Returned
25
22
20
Percentage
of Drugs Returned
(%)
15
15
9
10
6
6
5
0
Antihypertensives
Antidiabetics
Supplement
Antihyperlipidaemics
Antacids
RETURNED DRUGS – AMOUNT
(TABs/ CAPs)
NO
DRUGS RETURNED
AMOUNT
1
Metformin 500mg
5,284
2
Mecobalamin 500mcg
1,833
3
Calcium carbonate 500mg
1,477
4
Nifedipine 10mg
1,310
5
Trimetazidine 20mg
1,254
6
Acetylsalicylic acid 300mg
1,135
7
Prazosin 2mg
1,080
8
Perindopril 4mg
971
9
Labetalol 100mg
906
10 Diltiazem 30mg
820
RETURNED DRUGS - Amount
NO
DRUGS RETURNED
AMOUNT
11
Orlistat (Xenical)
781
12
13
14
Glibenclamide 5mg
Prazosin 1mg
Gliclazide 80mg
737
737
700
15
Lovastatin 20mg
655
16
Repaglinide 2mg
647
17
18
Propranolol 40mg
Sulfasalazine 500mg
600
586
19
Ranitidine 150mg
581
20
Omeprazole 20mg
487
RETURNED DRUGS –
COST (M’SIAN RINGGIT)
NO.
NAME OF DRUGS
TOTAL COST (RM)
1
Omeprazole 20mg
2,259.68
2
Orlistat (Xenical)
2,132.13
3
Olanzapine 10mg
664.84
4
Acarbose 50mg
592.76
5
Amlodipine 10mg
589.96
6
Losartan 50mg & Hydrochlorothiazide
12.5mg (Hyzaar)
510.15
7
Repaglinide 2mg
504.66
8
Mecobalamin 500mcg
494.91
9
Insulin regular (Actrapid) 300IU/3ml
475.00
10
Insulin pre-mixed 30/70 (Mixtard)
300IU/3ml
437.50
CASE STUDY
 PT: AHD
 AGE: 63 years old
 ETHNIC : Malay
 GENDER : Male
 OWN MEDICATION
(6 TYPES)
DRUG ASSESSMENT
NO DRUGS RETURNED AMOUNT ESTIMATED REASON FOR RETURN
COST (RM)
EXPIRY
DATE
(EXPIRED)
11/05
10/02
1 Acarbose 50 mg
2 Simvastatin 20 mg
370 tab
30 tab
751.10
11.10
Change to new medication
Excessive supply
3 Metformin 500 mg
4 Atorvastatin 10 mg
100 tab
60 tab
3.00
82.80
Excessive supply
Excessive supply
08/04
02/05
5 Mecobalamin 500 mcg
120 tab
32.40
Excessive supply
11/05
6 Ranitidine 150 mg
50 tab
14.50
Excessive supply
12/04
TOTAL
894.90
TOTAL COST OF UNUSED
DRUGS
RM 14,813.57
RECOMMENDATIONS
 The project should be continuous and be made a
regular program in more centers :
i) to account the amount of wastage;
ii) to encourage environmentally safe ways to dispose
drugs
iii) to identify medication wastage related issues
including non compliance, ADRs and side effects.
 Physicians are recommended to practice prudent
prescribing in chronic diseases.
 Patients should be educated on the need and
importance of adherence to medication, reporting of
side effects, ADRs, proper storage and disposal and
appreciation of the value of the drugs dispensed.
 A more comprehensive study is recommended to
investigate the issue of excessive stock.
CONCLUSION
Pharmacist involvement in medication
management review could address
issues of over-stocking, drug storage,
compliance, side-effects and/or adverse
drug reaction monitoring. The study
also indicates the need for an
appropriate method of disposal of
unused medication.
ACKNOWLEDGEMENT
Pn. Hasnah Ismail
Pn. Norliah Ardee
Pn.Fathimah