Development, implementation and evaluation of a sustainable medication-use process in the intensive care unit: a lean-based quality improvement study

Background In the Intensive Care Unit (ICU), substantial quantities of medication are wasted, negatively affecting ecological and economic sustainability. Aim This study aimed to develop, implement, and evaluate an ecologically and economically sustainable medication-use process to reduce medication waste in the ICU of a Dutch academic hospital. Method This lean-based quality improvement study comprised three phases: (I) Three-week baseline medication waste assessment in terms of quantity (i.e., disposed medication units) and economic value per 100 ICU beds per day. (II) Development and implementation of a sustainable medication-use process using lean principles. Causes of medication waste were identified among hospital staff using qualitative methods, and targeted interventions were identified and implemented accordingly. (III) Post-implementation effect evaluation of the sustainable medication-use process on medication waste. Results At baseline, a mean total of 113 units, worth €1037, were wasted daily per 100 ICU beds. Causes for medication waste were: insufficient knowledge among hospital staff about quantities and impacts of medication waste; suboptimal medication ordering, supplying and preparing, resulting in unnecessary medication waste; and patient’s therapy changes/discontinuation. Interventions implemented were: awareness campaigns on medication waste; adjustment of protocols and work processes to prevent excess order, supply and preparation of medication; and dispensing individually labelled medication to the patient following transfer or discharge. Implementing these interventions reduced medication waste by 31.8% to 77 units per 100 ICU beds per day, and economic losses decreased by 18.4% to €846. Conclusion Implementation of a sustainable medication-use process targeting staff’s knowledge and work processes, reduced the extent of wasted medications in the ICU and associated costs.