Fraser Health has hired a “roving” pharmacy assistant to collect and restock unused tablets and capsules at hospitals in Surrey and Langley in a bid to save thousands of doses of medication from incineration.
The pilot project, which will run from March to September, comes after a study discovered hospitals in the Vancouver Coastal and Fraser Health regions could save 461,000 doses and an estimated $415,000 each year by recycling unused medication dispensed by hospital pharmacists.
“When we were talking about this idea, pharmacists told us they’d always wondered if it was worth it,” said Aaron Tejani, a pharmacist with Fraser Health who was part of a team that studied the issue.
Tejani explained that a pharmacist’s first priority is patient care. So if a tablet costs one cent and the labour to restock it is nine cents, for example, would it be worth taking time away from patient care to do it?
“Are we putting our money in the right place?” he asked.
That question became more relevant as COVID-19 disrupted normal operations in hospitals across B.C. Before the pandemic, hospitals typically collected unused medication, with nurses putting it in a bin to be returned to the hospital pharmacy. That practice was suspended over fears it could spread the virus.
As the health emergency ended, medication recycling resumed and now “happens to varying degrees” in most hospitals, said Tejani.
Whether or not that medication will be sorted, credited in the electronic pharmacy system and returned to dispensing bins is dependent on different factors, including how busy the pharmacy is, how many staff are working or how full the hospital is at a given time. Some pharmacies have adopted a policy of only recycling the most expensive medications or the ones that are easiest to return to dispensing bins — based on staff capacity.
“When we talk to pharmacists, they say they want to do this, but the site-based pharmacists often get pulled away from it for more high-priority work (related to patient care),” said Tejani. As a result, a significant amount of medication is wasted.
In calculating the savings to the hospital system, the study looked at labour time and acquisition costs and packaging, and determined B.C. would save $415,000 each year across the 21 hospitals in the Vancouver Coastal and Fraser Health regions by restocking medications. It didn’t include the environmental benefits of not incinerating them.
The study took place at three hospitals, including Surrey Memorial, St. Paul’s and Lionsgate, where there was already a workflow in place to recycle medication. Researchers tracked the time it took, then calculated the money saved. Labour costs were subtracted from the return value of the recycled medication, with a formula used to estimate yearly savings.
The results of the study, which were published in the International Journal of Pharmacy Practice, were “so impressive” that Fraser Health is planning the pilot project at Surrey Memorial and Langley Memorial starting in March, according to a news release.
Instead of working within a hospital pharmacy, where other tasks might take priority, a pharmacy assistant will spend eight hours a week in Surrey, and four hours in Langley, restocking returned medication collected by the hospital pharmacies. The pharmacy assistant will also visit patient care wards and optimize the medicine return process for nurses.
In B.C., pharmacists divide and package medication for use in hospitals in plastic and foil wrap, either at the hospital pharmacy or a central location. The packaging contains a label indicating the drug’s name, lot number and expiration date, in addition to other information.
Tejani said Fraser Health’s infection control department sets safety protocols for returned medication. The program is only for tablets and capsules in intact packaging that isn’t set to expire and doesn’t include anything that requires cold-storage. IV products are already recycled and reused as much as possible.
“We’re not talking about something that’s been sitting in a nurses’s pocket,” he said.
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