A cautionary tale of multiple‐dose drug products: Fluticasone and salmeterol combination inhaler waste
Bibliographic record
Abstract
RATIONALE: Some drugs can only be dispensed in multiple-dose containers. Multiple-dose packaging may pose a problem for hospitals in terms of drug wastage and cost. Oral inhalers, such as fluticasone propionate and salmeterol combination inhalers, are only available as multiple-dose formats in Canada. OBJECTIVES: The objectives of this study are to quantify the amount of fluticasone propionate and salmeterol combination inhaler waste and to assess possible factors that could be contributing to waste. METHODS: A retrospective chart review of 189 patients was conducted. Patients were included if they had received an order for fluticasone propionate and salmeterol combination inhaler at one of the 12 acute hospital sites of Fraser Health Authority. The primary outcome was the proportion of patients who were dispensed one or more inhalers unnecessarily. The number of inhalers dispensed was compared with the number of inhalers needed to complete a patient's order duration. The chart was also reviewed for possible factors that could have contributed to extra inhalers being dispensed unnecessarily. RESULTS: Thirty-seven patients (19.6%) had at least one inhaler dispensed unnecessarily and thus wasted. About 17.4% of the total amount of inhalers dispensed were dispensed unnecessarily, and 76.3% of doses dispensed were wasted. The cost of inhalers wasted for our sample was $5151.12 (CAD). The most common factors that contributed to inhaler waste appeared to be loss of medication during patient transfers and storage of inhalers as wardstock. CONCLUSIONS: The use of drugs that are only available in multiple-dose formats results in significant drug wastage and unnecessary health care expenditure. To minimize wastage of drug product, procedures could be implemented to ensure that drugs are properly transferred with the patient when a patient transfers locations in the hospital. As well, a review of wardstock inventory may minimize waste. Further assessment of multiple-dose drug product waste and evaluations of methods to mitigate waste are encouraged.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.029 | 0.102 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.003 |
| Science and technology studies | 0.004 | 0.011 |
| Scholarly communication | 0.007 | 0.008 |
| Open science | 0.005 | 0.003 |
| Research integrity | 0.013 | 0.027 |
| Insufficient payload (model declined to judge) | 0.005 | 0.004 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".