IMSH2014 - Making Connections
Creating Simulated Pharmaceuticals from Laboratory Supplies
January 2014
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How to Supply Your Drug Habit
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#IMSH2014
Meet Our Team
Cory Soto, B.S., CPhT
Simulation Specialist Jamie StinerSimulation Operations Manager
Simulation Specialist
Rukhsana Khan, M.P.H.
Simulation Specialist
Daniel Noji, B.S.Programmer AnalystSimulation Specialist
Jeffrey Rusheen, M.D.Assistant Professor
Anesthesiology
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Disclosure(s)
We have nothing to disclose.
Commercial vendors mentioned in this presentation are merely used as examples. We do not receive any compensation from them.
January 2014
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#IMSH2014 IMSH2014 - Making Connections
Learning Objectives
Create a needs assessment to tailor the pharmaceutical production to your needs.
Demonstrate how to produce vials for use as simulated drugs with hands-on instruction.
Find ways to implement this new tool into your simulation center.
January 2014
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Does your Simulation Center…
January 2014
Use expired drugs?
Buy commercially available simulated drugs?
Make your own?
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Get The Right Tools for the Job
January 2014
Outside Diameter, or O.D.
Borosilicate Vial 0.9% NaCl (Normal Saline)
Syringe
Table Salt
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Get The Right Tools for the Job
January 2014
Flip-Off Cap
Stopper
Flip-Off Cap Crimper
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Meet SOPHIE
January 2014
Simulated Online Pharmaceutical Image Editor
No need for expensive image editing suites
Developed by the UCLA Simulation Center for use by other Simulation Centers at no cost
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What Does Your Center Need to Maintain Their Drug Habit?
January 2014
Common/Crash Cart Meds
Medications for Rare Conditions (Dantrolene for Malignant Hyperthermia, Blood Factors, etc.)
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Needs Assessment
January 2014
Do you see a need for simulated medications to enhance realism and learning during the scenarios?
Are there any injectable drugs you would like specifically created for your simulations? (If so, please include concentration and volume)
Do you have any suggestions for injectable drugs that may be useful for simulation, in general? (If so, please include concentration and volume)
Do you know of any colleagues who would be interested in pharmaceutical simulation or integrating simulated pharmaceuticals into their teaching at the Simulation Center? If so, please provide their name and I will contact them.
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Simulated Drugs Currently Available at UCLA
January 2014
Adenosine Famotidine MidazolamAmiodarone Flumazenil Naloxone
Atropine Furosemide NeostigmineCalcium chloride Glucagon NitroglycrinDexamethasone Glycopyrrolate Norepinephrine
Digoxin immune fab Heparin PhenylephrineDiltiazem Hydralazine Propofol
Diphenhydramine Insulin Rocuronium
Dopamine Labetalol Succinylcholine
Esmolol Magnesium sulfate VasopressinEtomidate Metoclopramine Verapamil
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The Cost of Production
Vials Cost Units Price Per Unit2 mL $362.78 1440 $0.255 mL $213.80 864 $0.25
10 mL $292.20 864 $0.3420 mL $297.89 720 $0.41
Subtotal $1,166.67Stoppers
13 mm $77.62 1000 $0.0820 mm $120.65 1000 $0.12
Subtotal $198.27Flip-Off Caps
13 mm $82.24 1000 $0.0820 mm $121.27 1000 $0.12
Subtotal $203.51Contents0.9% NaCl $5.05 3000 mL $0.002
Salt $7.99 4 lbs. $0.02Labels
Glossy Laser $19.97 100 $0.01Toner Cartridge $306.34 1 $0.01
Subtotal $326.31Crimpers
13 mm $152.00 1 $152.0020 mm $152.00 1 $152.00
Subtotal $304.00Syringes
60 cc $112.51 125 $0.90008
Total $2,316.32
HoursSim Tech Per Hour
Sim Tech Cost
Non-Tech Per Hour
Non-Tech Cost
Ordering 3 $20.00 $60.00 $14.00 $42.00
Production 20 $20.00 $400.00 $14.00 $280.00
Integration 3 $20.00 $60.00 $14.00 $42.00
Total $520.00 Total $364.00
Material Cost Labor Cost for 500 Vials
Labor Cost Per VialSim Tech Non-Sim Tech
$1.40 $0.73
Material Cost Per Vial2 mL 5 mL 10 mL 20 mL$0.45 $0.53 $0.63 $0.73
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Cost Per Vial
Vial Type Commercial Cost Tech Produced Vial Non-Tech Produced Vial
2 mL $1.32 $1.85 $1.185 mL $1.50 $1.93 $1.26
10 mL $1.74 $2.03 $1.36
20 mL $2.75 $2.13 $1.46
Vial Type Total Material Cost Simulation Tech Labor Non-Sim Tech Labor2 mL $0.45 $1.40 $0.735 mL $0.53 $1.40 $0.73
10 mL $0.63 $1.40 $0.73
20 mL $0.73 $1.40 $0.73
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Cost Analysis
January 2014
Total Yearly Cost Using In-House Simulated Drugs versus Commercial Drugs for Anesthesia Residents
Total Yearly Cost Using In-House Simulated Drugs versus Commercial Drugs for a Class of 60 Nursing Students
Vial Type Vials Produced Commercial Cost Sim Produced Non-Tech Produced10 mL 720 $1,252.80 $1,461.60 $979.20
Assumption: A year’s worth of simulated drugs for Anesthesia residents is based upon 3 vials of simulated drugs used during each simulated case, 3 cases per week, 4 times per month, 12 months per year, which equals a total of 432 vials (with an additional 68 vials as a buffer in case more are needed throughout the year)
Assumption: A nursing program with 60 students learning how to draw medications for intravenous administration. Each get three 10 mL vials of 0.9% NaCl to do this with. Each course occurring 4 times per year.
Vial Type Vials Produced Commercial Cost Tech Produced Non-Tech Produced2 mL 100 $132.00 $185.00 $118.00 5 mL 50 $75.00 $96.50 $63.00
10 mL 75 $130.50 $152.25 $102.00 20 mL 25 $68.75 $53.25 $36.50 Total 500 $406.25 $487.00 $319.50
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References
January 2014
1. Samosky J, Mikulis B, Bregman, R, Nelson, D: A Novel Intravenous Drug Recognition System for Medical Simulators Based on Direct Fluid Identification. Society for Simulation in Healthcare Scientific Abstract Guide 2012; 12: 941
2. Steadman RH, Coates WC, Huang YM, Matevosian R, Larmon BR, McCullough L, Ariel D: Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills. Critical Care Medicine 2006; 34:151-7
3. Rodgers D, Securro, Jr S, Pauley RD: The Effect of High-Fidelity Simulation on Educational Outcomes in an Advanced Cardiovascular Life Support Course. Simulation in Healthcare 2009, 4: 200-6
4. Qayumi K, Donn S, Zheng B, Young L, Dutton J, Adamack M, Bowles R, Cheng A: British Columbia Interprofessional Model for Simulation-Based Education in Health Care. Simulation in Healthcare 2012; 7:295-307
5. Struys MMRF, De Smet T, Mortier EP: Simulated Drug Administration: An Emerging Tool for Teaching Clinical Pharmacology During Anesthesiology Training. Clinical Pharmacology & Therapeutics-Nature 2008; 84: 170-4
6. Kimble Chase Life Science and Research Products LLC. Web site.
7. http://labglass.kimble-chase.com/category/serum-vials&bc=100. Accessed March 18, 2013.
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How to Reach Us
January 2014
Any questions or comments regarding the material presented can be directed to the team at:
E-mail: [email protected]
Visit our website at: www.sim.ucla.edu