(920) Evaluation of PRN IV Hydromorphone Waste in the ICU

Introduction: Hydromorphone is a full opioid agonist used for pain management in the intensive care unit (ICU), for which there are several product sizes available on the market. Efforts to reduce preventable hydromorphone drug waste is not only a crucial component for drug cost-minimization but an opportunity to minimize diversion. The aim of this project was to evaluate the amount of intravenous (IV) hydromorphone waste and determine if a standard product size or dose should be utilized to decrease cost and minimize potential for drug diversion.

Methods: This retrospective, single-center medication use evaluation at a large academic medical center included ICU patients ≥ 18 years of age who received hydromorphone 0.2 to 0.5 mg IV PRN. Patients included were randomly selected from a convenience sample taken from the total population of patients from all adult ICUs. The primary outcome of this evaluation was to assess cumulative waste due to PRN IV hydromorphone in the ICU setting. Secondary outcomes included cost associated with hydromorphone waste and usage of hydromorphone in addition to PRN oxycodone with overlapping indications.

Results: A total of 200 patients were included, accounting for 1,306 administrations and 1,171 wasted hydromorphone doses. In total, 338.9 mg of hydromorphone was wasted resulting in a loss of $1,241.63. When extrapolated to all patients who received PRN IV hydromorphone during the 1-year study period, the total cost due to waste was $19,934.01. Furthermore, 51% of patients had PRN oxycodone ordered in addition to hydromorphone for the same indication, for which 360 hydromorphone doses were given prior to oxycodone.

Conclusions: The waste observed in association with hydromorphone has resulted in a substantial financial burden and the number of doses wasted provides unnecessary opportunities for diversion. Utilizing a standardized product size and dose would reduce the financial burden and limit opportunities for potential diversion. When duplicate therapies are ordered for the same indication, the addition of a clarifying multi-modal approach PRN requirement, will help best address when each agent should be given.