Contemplating Kits……..

Jenny TinsonProduction Pharmacist, Southlands Hospital

Hands up…..

• Who packs crash kits?• Who thinks money could be saved in the

process?

Objective of session

•Share information•Share ideas•Improve efficiency of kit process

•Hand-out – for interactive use!

Western Sussex crash box audit

• 2 years of data• 190 kits for 600 bed Trust (W&S only)• 225 recorded uses of kits• 514 kits returned for replenishment (expired)• Average kit shelf life 5.5 months• £4,000 expenditure on ‘used’ PFS• £21,000 expenditure on ‘expired’ PFS

NumbersUsed Expired

Adrenaline 1:10000 10mL 400 1900Amiodarone 300mg/10mL 50 500Atropine 3mg/10mL 120 500Calcium chloride 10% 10mL 30 350Sod. Bicarbonate 8.4% 50mL 30 200

That’s £1.8m per year on expired drugs if extrapolated to 170 acute Trusts in England

Wider kit survey

• Jim Armstrong asked for similar figures nationally

• Response from 11 Trusts inc. WSHT• Huge variety of kit contents• No-one had looked at use/expiry figures

Drug Trust A Trust B (adult)

Trust C (adult)

WSHT WSHT Radiology

Trust E Trust F Trust G Trust G Trust H Trust I Trust I FPH

Main(or only) or back-up Main Main Main Main Main Main Main Main Back-up Main Main Back-up Main

Adrenaline 1:10000 PFS 10mL 4 9 6 6   6 8 7   10 8   6Adrenaline 1:1000 PFS 1ml (no needle)             1     1      Adrenaline 1:1000 with needle for anaphylaxis       3               2  Adrenaline 1 in 1,000 amp 1ml                       10 2Adrenaline 1:1000 5mg in 5mL amp 1                                                   Adenosine 6mg in 2mL                 6     6                             Aminopylline 250mg/10mLs amps         10                                           Amiodarone 300mg in 10mL PFS 1 1 1 2   1 1 1   2 2   2Amiodarone 150mg/3mLs amps     10                                               Atropine 3mg in 10mL PFS 1 1 1 1   1 1   2 1      Atropine 1mg in 5ml PFS             1     3   3 3Atropine 600mcg pFS         2                                           Calcium chloride 10% PFS 1   1 2   1 1   1 2   2 1                           Chlorphenamine 10mg /1mL amps         1

            5 1           

               Diazemuls 10mg/2mLs amps         10       10                                   Glucose 50% mini-jet 50ml           1     1 1                                 Hydrocortisone 100mg vial with diluent         3                Hydrocortisone Sodium Phosphate amp 100mg in 1mL                       5  Hydrocortisone Sodium Succinate 100mg vial (no diluent)

                        2                           Magnesium Sulphate 50% PFS 4ml             1 1   2   2 1Magnesium sulphate 50% amp 10mL   10                                                 Naloxone 2mg in 2mL PFS     1                    Naloxone 2mg in 2mL PFS             1            Naloxone 400mcg/1mL ampoules                         3Naloxone 400mcg/1mL MJ                 2                                   Potassium Chloride 40mmol in 0.9% NaCl 100mls bag                       2                             Salbutamol nebs 5mg in 2.5mL                       5                             Sodium bicarbonate 8.4% 50mL Minijet     1 1   1 1   1 2     1

                           Sodium chloride 0.9% 10mL amp 2   10                    

                           Water for Injection 2ml amp                         1

Not to mention Anaphylactic kits, Paediatric Crash Kits.…….

What can we do with this data?

• Consider re-use of near-expired drugs? How could this be done? Please fill in your sheets now…..

Re-use of short-dated drugs from within own TrustPros• Can make an assumption

about storage temperatures and conditions

• Minimal (if any)transit temperature fluctuations

• All stock ‘owned’ by Trust• Reasonably easy to keep audit

trails of drug purchase and use• Minimises waste for

incineration• Saves ££ (QIPP target)

Cons• Does the Trust have a

location in which to re-use the drugs?

• Robust expiry date checks needed, frequently

What other pros and cons did you have?

Re-use of short-dated drugs from external Trusts

Pros• All stock ‘owned’ by Trust• Reasonably easy to keep

audit trails of drug purchase and use

• Saves ££ (QIPP target)

Anything else?

Cons• Cannot make an assumption

about storage temperatures and conditions

• Transit temperature fluctuations between sites

• Robust expiry date checks needed, frequently (by them)

• Managing process – do customers remove drugs they want before returning kits to us?

• How manage stock finances on JAC?

• Wholesale dealing rules?

National format for kitsPros

• Medical staff know what’s in box in emergency

Cons

• Supply problems impact all packing units at same time (2 main PFS suppliers)

Strive to have a nationally agreed adult/paed cardiac arrest and anaphylactic kits?

Would any national body e.g. Resuscitation Council take this forwards?

Is this worth pursuing?

Thanks for your participation

Aiming to collate data for a wider audience

Kits…don’t we just love them…