Hidden costs of multiple-dose products: Quantifying ipratropium inhaler wastage in the hospital setting

Abstract

Background: Previous studies have quantified wastage involving drugs that are available in multiple-dose formats. Ipratropium bromide by metered dose inhaler (MDI) is commonly used in hospitals, and may be contributing to waste of pharmaceutical and financial resources. Objectives: The primary objective was to quantify the number of patients in the authors' health authority with waste of at least 1 ipratropium MDI. Secondary outcomes were the total number of wasted inhalers, the total number of wasted doses, the cost of wasted inhalers, the cost of wasted doses, and possible factors or explanations for inhaler wastage. Methods: A retrospective chart review was conducted for patients with an order for ipratropium by MDI in 2019 at one of the acute care sites within the health authority (predefined sample size 336). The number of inhalers dispensed was compared with doses received to determine the number of inhalers wasted. Each patient's electronic chart was audited for possible factors and explanations for wasting of inhalers. Results: Of the 336 patients, 79 (24%) had wastage of at least 1 inhaler. In total, 34% (98/290) of all inhalers dispensed and 87% (50 693/58 000) of all doses dispensed were wasted. The total cost of wasted inhalers for the sample population was $2156. The most common reason for inhaler wastage was no doses being administered after an inhaler was dispensed; the second most common reason was dispensing of an extra inhaler associated with a change in directions for use. Conclusions: The use of multiple-dose MDI products in hospitals can lead to wastage of drugs and financial resources. Procedures need to be implemented to aid pharmacy and nursing staff in ensuring the most efficient use of these products. Evaluations of pilot methods to mitigate this waste are encouraged.