An Assessment of the Intraoperative Anaesthesia Drug Utilization Inefficiency at the Kenyatta National Hospital

Abstract

Background: Drug use inefficiency in operating rooms has in recent years become an area of concern due to its detrimental financial and ecological effects that subsequently affect patient outcomes. Anaesthesia makes a significant contribution to this wastage. Establishing the extent of these anaesthesia drug utilization related inefficiencies in operating rooms will be an initial step in uncovering the overall severity of wastage in KNH operating rooms and its associated financial impact. Study Objective: To establish the extent of intraoperative anaesthetic drug utilization inefficiency at the Kenyatta National Hospital Study Design: This was a single population cross-sectional study undertaken in the operative theatres of the Kenyatta National Hospital assessing anaesthesia drug utilization inefficiencies during surgical procedures. Recruitment of anaesthesia service providers, who were the primary study participants, was based on the eligibility criteria chosen and informed consent was obtained from them. Consent was also obtained from the patients undergoing surgical procedures during the study period. 388 surgical cases were observed consecutively by the principal investigator assisted by research assistants. Information collected included data on the anaesthesia service providers, the nature of the surgical cases, and the type, number and cost of the anaesthesia drugs. The extent of anaesthesia drug use inefficiency and its associated financial implications was then analyzed. All relevant ethical considerations will be adhered to during the collection of the data Results: Drug use inefficiency during the study was found to be 17.6%. The % contribution to the overall quantity of unused drugs from cases involving patients <12yrs was higher (67.15%) than that from cases involving patients ≥12 yrs. (38.15%) The drugs that demonstrated the highest inefficient use were paracetamol (36.7%), lignocaine (22.13%, and propofol (11.7%) and cefazolin (11.76%). The drugs that contributed the highest to the unused drug costs were cis-atracurium (32%), dexmedetomidine (20.4%) and propofol 10mg/ml (10.8%). Factors influencing drug use inefficiency (P-<0.5) were patient age, type of anaesthesia and surgical type/ specialty/ length Conclusion: There was a considerable amount drug wastage observed that resulted in significant financial implications to the patients and hospital. Steps to reduce these inefficiencies that would include provision of vial sizes that cater to the different patient age groups, development of drug administration protocols and anaesthesia service provider education on drug costs and waste reduction strategies