Rationalising drugs in the operating theatre, Operating Services, Critical Care and Anaesthesia (OSCCA) and Pharmacy

Project completed as part of the 2023-4 Sheffield Teaching Hospitals Green Team Competition.

Team members

• Tim Orr (Consultant Anaesthetist)

• Caroline Dalton (Recovery Lead Practitioner)

• Matt Clarke (Principal Pharmacist, Medicines Information)

Setting / patent group: Theatres

Issue:

Medication storage in theatres. Although generally very safe, anaesthesia is a specialty with a high risk of adverse events which need to be managed rapidly to prevent patient harm. For this reason, many medications are immediately available in case their use becomes necessary. Good medicines handling practice prohibits the splitting of boxes to individual ampoules/doses and so whole boxes of medications that are rarely used are stocked in multiple areas in case their use becomes necessary and sometimes to accommodate clinician preference. Many of these boxes expire unopened and require disposal and replacement. There is a limited storage space for medications in operating theatres, the visual appearance of products may change from week to week due to manufacturer preferences or supply chain problems necessitating alternative sourcing arrangements and different medications often look similar. The risk of medication errors in this setting is high with significant potential harm to patients and there are multiple examples in the literature and locally of this. In addition to patient harm, the impact of medication errors on the staff involved is significant and also harmful.

Intervention:

Reducing the medication burden in theatres whilst maintaining adequate availability of emergency medications has the potential to bring safety, financial, social and environmental benefits. We reviewed all medications in the anaesthetic rooms in our operating theatres to identify which medications were not used, could be ordered less (low use drugs) and moved to a centralised location.

Outcomes:

Any reduction in the number of medications stocked within anaesthetic rooms and theatres, whilst maintaining an accessible central supply, reduces the chaos and variation in the drug cupboards. This reduces the risk of medication error with consequent benefits to patient safety provided rapid and reliable access is maintained for relevant emergency medications. As part of the audit, several examples of poor drug management practices such as local anaesthetics stored with other drugs and expired drugs were identified and rectified. Feedback to the relevant staff groups provided an opportunity to improve medicines management with a consequent reduction in risk to patient safety.

The modelled carbon saving for 12 elective theatres and 3 obstetric is £11,299.73.and 7,017.3 kgCO2e, equivalent to driving 20,723 miles in an average car. A survey was sent to all obstetric anaesthesia consultants. 11/14 responded (79%).

• 10/11 (91%) were supportive of the principle of centralising low-use medications.

• 9/11 (82%) had no concerns about the proposal. 2/11 (18%) were concerned it could delay emergency treatment or that they would “forget where they are”.

• 10/11 respondents could see benefits in centralising stock and thought there were sustainability savings, 8/11 (73%) cost savings and 7/11 (64%) reduction in risk from simplifying the cupboards.

We also sent a survey to our pharmacy technician who strongly thought this intervention would make their job easier, save them time, save money and reduce wastage

Key learning point

MDT / cross-departmental communication and aligning the aims with wider organisational goals has been key to this project. Centralising low-use drugs within our operating complexes is achievable, clinically acceptable and will result in financial savings as well as environmental, workplace and potentially safety improvements. We have consulted with governance, pharmacy and anaesthetic colleagues to develop a process to implement this change across the trust which will bring larger savings.