Medication Use Evaluation and Cost Minimization Analysis of Injectable Nicardipine in a Community Hospital

Transcription

1 Medication Use Evaluation and Cost Minimization Analysis of Injectable Nicardipine in a Community Hospital Christopher Brown, PharmD PGY-1 Pharmacy Resident Norman Regional Health System April 8, 2016 Disclosures The authors of this presentation have NO financial or personal relationships with commercial entities in regards to the subject matter of this presentation

2 Objectives 1. Identify the nicardipine strategy selected by this study, and reasons why it was selected. 2. Describe the category of compounded sterile preparation (CSP) and beyond use date (BUD) assigned to the injectable nicardipine strategy chosen. Introduction Nicardipine (Cardene ) Dihydropyridine calcium channel blocker Used intravenously in the setting of: Acute hypertension Ischemic stroke Intracranial hemorrhage

3 Purpose Determine the injectable nicardipine strategy that will provide the most cost savings, while taking into consideration the workload implications to the pharmacy department. Nicardipine (Cardene ) Branded premixed bags: almost exclusively used at NRHS Identified as a potential cost savings measure by pharmacy administration and clinical pharmacy staff

4 Methods Retrospective electronic medical record review Data collection period: 6 months (12/1/14 to 5/31/15) Data analysis: Number of doses administered Frequency of doses administered Indication for use Inclusion criteria Age 18 years Injectable nicardipine administered Exclusion criteria Methods (continued) Age < 18 years Injectable nicardipine not administered

5 Charts Reviewed (n = 202) Included (n = 67) Excluded (n = 135) Total Doses Administered: 408 Compounded: 80 bags Premixed: 328 bags Injectable Nicardipine Options 1. Premixed (current process) Pharmacy rarely compounds 2. Compounded by pharmacy 3. Nicardipine kit 4. Variations utilizing a combination of the above options

6 Premixed Nicardipine Premixed cost: 20 mg/200 ml: $79.54/bag 40 mg/200 ml: $156.98/bag Most expensive option Low burden on pharmacy staff Readily available for use Compounded Nicardipine Compounded cost: 25 mg/250 ml: $15.91/bag Least expensive Most burden on pharmacy staff Longest time from drug order to patient use

7 Nicardipine Kit contains: Nicardipine 25 mg vial 0.9% sodium chloride 250 ml + + Vial2Bag Adapter Nicardipine Kit Nicardipine Kit: 25 mg/250 ml: $17.61/kit Second cheapest option Low burden on pharmacy staff Readily available in automated dispensing cabinets Assembled by nursing prior to administration

8 Cost Minimization Analysis 1. Premixed bags only: current process 2. Premixed initial drip and pharmacy compounded subsequent doses 3. Nicardipine kit only 4. Nicardipine kit initial drip, pharmacy compounded subsequent doses $60,000 Current Process vs. Premixed Initial Bag and Pharmacy Compounded Subsequent Bags Cost per year $50,000 $40,000 $30,000 $20,000 $10,000 $- $54,724 $33,214 $21,510 Current Process Projected Projected Savings

9 $60,000 Current Process vs. Nicardipine Kit Alone Cost per year $50,000 $40,000 $30,000 $20,000 $10,000 $- $54,724 $40,353 $14,371 Current Process Projected Projected Savings Current Process vs. Nicardipine Kit for Initial Drip and Pharmacy Compounded Subsequent Doses $60,000 Cost per year $50,000 $40,000 $30,000 $20,000 $10,000 $- $54,724 $13,211 $41,513 Current Process Projected Projected Savings

10 Results Nicardipine kit (strategy chosen) Projected cost savings: > $40,000/year Least burdensome to the pharmacy Available for immediate use Pharmacy can still compound in certain situations when needed Nicardipine Kit Compounded Sterile Product (CSP) Category: immediate use Administration: to begin no later than 1 hour following assembly Beyond use date (BUD) and time: 1 hour

11 Implementation Establish new process: completed Order set review/update: completed Educate nursing/pharmacy staff: completed Load nicardipine kits in automated dispensing cabinets and begin utilization: currently underway Future Directions Perform post-implementation analysis to assess impact of the new process Determine other medications that may benefit from utilization of a Vial2Bag adapter kit

12 Self-Assessment Self-Assessment 1. Why was the nicardipine kit strategy chosen by our institution? A. Significant cost savings B. Low amount of burden on pharmacy staff C. Readily available from automated dispensing cabinets D. All of the above

13 Self-Assessment 2. What CSP category is the nicardipine kit assigned to after assembly? A. Low-risk level CSP B. Medium-risk level CSP C. High-risk level CSP D. Immediate-use CSP Acknowledgements Kim Whitley, PharmD, BCPS Lisa Mayer, PharmD, BCPS

14 Questions? Medication Use Evaluation and Cost Minimization Analysis of Injectable Nicardipine in a Community Hospital Christopher Brown, PharmD PGY-1 Pharmacy Resident Norman Regional Health System April 8, 2016