Evaluation of Operational Efficiencies in Pediatric Pharmacy Batch Production

PURPOSE: It is well published that more frequent batch production leads to less waste however the optimal batch production and delivery schedule for a pediatric institution is unknown. Pediatric institutions are left to make individualized decisions and often create complex medication delivery systems with the goal of reducing drug waste by increasing batch frequency. The purpose of this project is to evaluate operational efficiencies at six points in time, taking into account different batch production and delivery schedules. METHODS: This is a retrospective, single arm study that compared operational efficiencies and waste at six points in time with different batch production and delivery schedules. All doses produced via the central pharmacy batch printed in January 2011, August 2011, January 2014, August 2014, January 2018, and August 2018 were identified from the electronic medical record. Doses that were printed yet not administered were identified. The percent waste and total cost of waste were calculated. Production and delivery time were calculated based on the batch production and technician workflow schedule at each respective time. Using current technician average salary, cost of delivery time was calculated. Once the above data was obtained, the percent waste, cost of waste, cost of production time, and cost of delivery time in January and August of 2011, 2014, and 2018 were compared to evaluate each batch schedule for operational efficiencies. RESULTS: Batch times for January and August 2011, and January 2014 were similar with six batch prints each with a print update and delivery following production. The proportion of medications wasted that were produced in the batch were 17.58%, 16.06%, and 14.15% respectively. In August 2014 the batch production schedule changed significantly to have up to eleven batch prints with times and frequency depending on dosage form and only five deliveries each day. 16.63% of medications produced in the batch were wasted. Batch production in January and August 2018 had ten print times, every two hours throughout the day, with six deliveries. Batch waste was 11.71% and 12.97% respectively. CONCLUSION: Removing high-cost medication from batch production as well as increasing production frequency has the most substantial effect on waste reduction. Throughout the years, a substantial amount of the production moved out of the central batch pharmacy to the satellites, shifting the work to a more just in time production schedule. With a reduced number of doses in the batch the staff were able to become more efficient in production and delivery time. Hospital pharmacy departments need to continually optimize their operations by regularly evaluating medications produced in the batch, batch frequency, and production and delivery time to become more efficient in this climate of rising medication cost.