1. Reducing Repackaged Medication Waste in the Pharmacy Department

2. Objectives Discuss a process for decreasing repackaged waste Describe methods to streamline the distribution of repackaged medications

3. Project Charter Project Name: Reducing Repackaged Medication Waste in Pharmacy Problem Statement : Waste is defined as the Total Units Ordered minus Total Units Charged to the Patient. It has been identified that 34% of the Top 25 Repackaged Brand Medications ordered annually by the pharmacy department ends up as waste. Repackaged Branded Medication waste cost the Pharmacy department over $10,000 in 2010. Project Objective: The objective of the project is to decrease the percentage of repackaged medications wasted by 10%. Scope: To look at the processes of the repackaged solid medications (start point: when ordered to end point: drug expires)

4. By identifying how to prevent repackaged oral solid medication waste in the Pharmacy Department the potential benefits: Save the department/facility $5,000 +annually Change processes to minimize repackaged waste Manage inventory in automated dispensing cabinets Justification

5. Process Steps Determine Top 25 Medications Create Par Levels Ordering Repackaging 1 2 3 4 5 Stocking

6. Determine Top 25 Medications 1 Review formulary Run reports:80/20 wholesaler report by dollars Perform a physical inventory on the Branded bulk solid oral medications Review waste records (if available) Run reports of usage from automated dispensing machines Run charge reports for 25 medications identified

7. Generic Name% of Waste VORICONAZOLE24% TENOFOVIR DISOPROXIL FUMARATE14% RITONAVIR14% EMTRICITABINE11% PREGABALIN9% NELFINAVIR MESYLATE5% VITAMIN K (PHYTONADIONE)5% ACETAZOLAMIDE5% LOPINAVIR/RITONAVIR4% MESALAMINE4% CINACALCET HCL3% EFAVIRENZ3% COLESEVELAM HCL3% PARICALCITOL3% RALOXIFENE HCL2% DIPYRIDAMOLE/ASPIRIN2% RANOLAZINE1% MONTELUKAST SODIUM1% ENTACAPONE0% FLUCYTOSINE0% DOXERCALCIFEROL 0.5MCG-2% SEVELAMER HCL-3% OLANZAPINE-3% PROPAFENONE HCL 225MG-3% LANTHANUM CARBONATE-4%

8. Generic Name% of Waste VORICONAZOLE24% TENOFOVIR DISOPROXIL FUMARATE14% RITONAVIR14% EMTRICITABINE11% PREGABALIN9%

9. D Define M Measure A Analyze I Improve C Control

10. Create Par Levels 2 Run a report on products ordered in the last quarter Classify par levels based on history or how many days of inventory on hand you desire Create your definition of slow medium or fast moving products

11. Ordering 3 Review order for high dollar solid oral medications Run report for current orders Do an inventory count in RX and Cabinets Only order if you have less that 3 days worth of medication

12. Repackaging 4 Only repackage slow moving items for 2-3 days quantity needed Repack medium and fast movers based upon Par levels

13. Stocking 5 Determine if product should be stocked outside Pharmacy If stocking in automated machine set PAR levels for 2 days

14. Conclusion Create Par levels for all bulk oral solid products Create ordering system that includes total inventory levels and charges Unused stock outside the Pharmacy should be returned to Pharmacy on a routine basis Stock outside the Pharmacy should be rotated in machines Create guidelines for repackaging to reduce waste