General Articles: Brief Report
Drug waste contributes to environmental contamination with potential adverse ecologic effects.1,2 The environmental toxicity of several anesthetic drugs is summarized in Table 1. Propofol is an environmental hazard because it does not degrade, accumulates in fat, is toxic to aquatic organisms, and requires incineration to be destroyed.a Drug wastage also increases health care costs.3,4,5,6,7,8 Drug wastage can be reduced by providing feedback on wastage to clinicians.7,9,10 We studied propofol usage and wasting at a surgical care center with 20, 50, and 100 mL vials of propofol.
We analyzed pharmaceutical waste bins in 8 operating rooms of a small surgical suite from July 2008 through April 2009. The bins were emptied at least each week or when 3/4 full and sorted by hand by trained technical staff wearing appropriate personal protective equipment. The weight of propofol discarded in pounds (including vials and syringes) was recorded as an indicator of waste generation. We also collected self-reported data from our PYXIS® drug dispensing system on the quantity of drugs wasted at the bedside (e.g., discharged by the caregiver into the toilet, sink, or other water source). These data were combined with amounts (mL) of drug discarded into the pharmaceutical waste bins.
In August 2008, we eliminated the 50 and 100 mL propofol bottles from the formulary, replacing them with 20 mL propofol bottles. We examined the use and waste of propofol based on 153 records extracted from the PYXIS system. The accuracy of these records was assessed by comparing reported wastage to random visual checks of Sharps containers and trash receptacles, and random personal audits of staff knowledge and practice for disposing of pharmaceutical waste.
As depicted in Table 2, propofol was the most widely dispensed and wasted drug at the facility. Propofol accounted for 45% of the total drug waste by mL. Eliminating the 50 and 100 mL bottles of propofol reduced the facility's propofol waste from 29.2 mL/day/bin to 2.8 mL/day/bin.
Reduction in drug wastage occurs with feedback.7,9 The behavior is reasonably understood for volatile anesthetics.10 Reducing the size of propofol vials reduced the wastage of propofol at our facility. By reducing propofol wastage, the hospital reduced cost and the environmental impact of propofol, which does not degrade in nature, accumulates in body fat, and is toxic to aquatic life.
Name: Russell F. Mankes, PhD.
Contribution: This author designed the study, conducted the study, analyzed the data, and wrote the manuscript.
Attestation: Russell F. Mankes has seen the original study data, reviewed the analysis of the data, approved the final manuscript, and is the author responsible for archiving the study files.
This manuscript was handled by: Steven L. Shafer, MD.
The author thanks Laurie DeWeerdt, BS for technical support.
a USP Propofol Material Safety Data Sheet (MSDS) United States Pharmacopeial Convention, Inc. 2006.
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