Pharmaceutical Waste Reduction Strategies

Minimize size of containers

Higher volume containers of medication are replaced with smaller containers to avoid waste from partial use, where appropriate.

Examples of Applying this Strategy

Generic Drug: Propofol In a 2012 study of eight operating rooms, propofol was found to be the most commonly wasted drug. 50mL and 100mL containers of propofol were removed and replaced with the smaller 20mL size vials. The study reported reduced waste from 29.2 mL/day/bin to 2.8 mL/day/bin. Proprietary Drug(s): Diprivan, Propofol, Propoven Delivery Method(s): Intravenous (IV) For more information: Mankes, Russell F. "Propofol Wastage in Anesthesia." Anesthesia & Analgesia, 13 March 2012. Web. 13 June 2013. Russell F. Mankes, PhD. 141 Mohawk Drive Schenectady, NY, 12303-5732 Email: rmankes@nycap.rr.com

Generic Drug: Agatroban In a 20 patient study at the University of Michigan Hospitals, use of 50 mg/50 mL and 125 mg/125 mL argatroban products reduced drug waste resulting in projected cost savings to 1% and 2%, respectively, compared to that of the 250 mg/250 mL product. Proprietary Drug(s): Agatroban Delivery Method(s): Intravenous (IV) For more information: Lose, Jennifer, et al. "Cost Containment for Agratroban Through Reduction in Drug Waste: Experience at a Single Center." Pharmacy Times, Mar. 2013. Web. 10 June 2013. Jennifer Lose, PharmD, BCPS Mayo Clinic, 200 First St SW Rochester, MN 55905 Email: Lose.Jennifer@mayo.edu

Generic Drug: Balanced Salt Solution Surgery centers should consider purchasing the smallest containers of BSS which will suffice for a given procedure. Proprietary Drug(s): BSS, Balanced Salt Delivery Method(s): Ophthalmic Solution

Generic Drug: Dextrose Hennepin County Medical Center found that two sizes of glutose gel were being ordered, 15 gram for crash boxes and 45 gram for diabetics, although only 30 grams is recommended by the facility's diabetics committee. Purchasing only the 15 gram size tubes saves the facility $345 annually. Proprietary Drug(s): Glutose Delivery Method(s): Oral Gel For more information: http://www.mntap.umn.edu/health/resources/94FS.PharmWaste.pdf MnTAP 200 Oak Street SE, Sutie 350 Minneapolis, MN 55455-2008 Phone: (612) 624-1300 Fax: (612) 624-3370

Generic Drug: Epinephrine The pharmacy and surgery center in a Missouri health care facility have worked with physicians to reduce the bottle sizes of epinephrine from 500 ml to 250 ml per procedure. Proprietary Drug(s): Epinephrine Delivery Method(s): Intravenous (IV)

Generic Drug: Iodine povacrylex/Isopropyl alcohol The University of Minnesota Medical Center - Fairview case study suggested switching from 26 ml sizes of Duraprep to the 10 ml size where appropriate Proprietary Drug(s): Duraprep, Duraprep Delivery Method(s): Topical Ointment/Cream For more information: "Reducing Waste from the Operating Room." MnTAP, University of Minnesota, April 2011. Web. 13 June 2013. A.J. Van den Berghe 200 Oak Street SE, Suite 350 Minneapolis, MN 55455 Phone: 612-624-4653 Email: mntap@umn.edu

Generic Drug: Nitroglycerin Hennepin County Medical Center in Minnesota reduced the size of the nitroglycerin bottle in their crash boxes from 100-count to 25-count. Proprietary Drug(s): Nitroglycerin, Nitrostat Delivery Method(s): Oral Tablet For more information: Smith, Charlotte, Pines, Eydie et al. "Managing Pharmaceutical Waste: A 10-Step Blueprint for Healthcare Facilities In the United States." Practice Greenhealth, 2008. Healthcare Environmental Resource Center Phone: (734) 995-7989

Additional Resources

Daughton, Christian G. Cradle-to-Cradle Stewardship of Drugs for Minimizing Their Environmental Disposition While Promoting Human Health. I. Rationale for and Avenues toward a Green Pharmacy. Environmental Health Perspectives. 2003 May; 111(5):757¿774. http://www.epa.gov/esd/bios/daughton/green1.pdf)