1. Contemplating Kits…….. Jenny Tinson Production Pharmacist, Southlands Hospital

4. Hands up….. Who packs crash kits? Who thinks money could be saved in the process?

5. Objective of session Share information Share ideas Improve efficiency of kit process Hand-out – for interactive use!

6. 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

7. Numbers UsedExpired Adrenaline 1:10000 10mL4001900 Amiodarone 300mg/10mL50500 Atropine 3mg/10mL120500 Calcium chloride 10% 10mL30350 Sod. Bicarbonate 8.4% 50mL30200 That’s £1.8m per year on expired drugs if extrapolated to 170 acute Trusts in England

8. 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

9. DrugTrust ATrust B (adult) Trust C (adult) WSHTWSHT Radiology Trust ETrust FTrust G Trust HTrust I FPH Main(or only) or back-upMain Back-upMain Back-upMain Adrenaline 1:10000 PFS 10mL4966 687 108 6 Adrenaline 1:1000 PFS 1ml (no needle) 1 1 Adrenaline 1:1000 with needle for anaphylaxis 3 2 Adrenaline 1 in 1,000 amp 1ml 102 Adrenaline 1:1000 5mg in 5mL amp1 Adenosine 6mg in 2mL 6 6 Aminopylline 250mg/10mLs amps 10 Amiodarone 300mg in 10mL PFS1112 111 22 2 Amiodarone 150mg/3mLs amps 10 Atropine 3mg in 10mL PFS1111 11 21 Atropine 1mg in 5ml PFS 1 3 33 Atropine 600mcg pFS 2 Calcium chloride 10% PFS1 12 11 12 21 Chlorphenamine 10mg /1mL amps 1 51 Diazemuls 10mg/2mLs amps 10 Glucose 50% mini-jet 50ml 1 11 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 11 2 21 Magnesium sulphate 50% amp 10mL 10 Naloxone 2mg in 2mL PFS 1 1 Naloxone 400mcg/1mL ampoules 3 Naloxone 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 11 11 12 1 Sodium chloride 0.9% 10mL amp2 10 Water for Injection 2ml amp 1 Not to mention Anaphylactic kits, Paediatric Crash Kits.…….

10. 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…..

11. Re-use of short-dated drugs from within own Trust Pros 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?

12. 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?

13. National format for kits Pros 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?

14. Thanks for your participation Aiming to collate data for a wider audience Kits…don’t we just love them…