(894) Antibiotic Waste in the Pediatric Intensive Care Unit

Introduction: Pharmaceutical waste, defined as unused and discarded medication doses, contributes to the increasing burden of waste within healthcare. This unnecessary waste can have harmful consequences on the environment, our patients, and our healthcare system, particularly as critical drug shortages increase in frequency. The objective of this study was to quantify and characterize antibiotic waste in the pediatric intensive care unit (PICU) at our institution.

Methods: We retrospectively reviewed all antibiotics ordered in the PICU that were returned to and / or discarded by the pharmacy between January 2022 and June 2024. The number of monthly discarded doses was analyzed via a run chart to assess trends in waste over this time period. Pareto charts were created to review the most frequently discarded antibiotics and the time between medication initiation and date of discard.

Results: Within the 30-month time frame, 1,895 antibiotic doses were discarded in the PICU, with a monthly rate of 63.2 discarded doses. There has been an upward trend in the number of discarded doses over the last 9 months; 132 antibiotic doses were discarded in June 2024. The most commonly discarded antibiotics were cefepime (18.4%), meropenem (11.5%), and ceftriaxone (7.4%). Of discarded antibiotics, 40% were discarded on the day of medication initiation and nearly 75% were discarded within 72 hours of being ordered.

Conclusions: There is a substantial amount of antibiotic waste in our unit, which typically occurs shortly after the medication was ordered. Next steps include investigating the environmental, financial, and clinical impacts of this waste. We will use the information learned in this and subsequent studies to identify and implement targeted strategies to reduce antibiotic waste via quality improvement methodology.