University of Twente Student Theses


Reducing unused medication at Isala Zwolle by redistribution

Mourik, J.B. (2023) Reducing unused medication at Isala Zwolle by redistribution.

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Abstract:This thesis aims to improve the sustainability of a Dutch hospital by reducing medication waste. The Dutch healthcare industry is one of the most polluting industries in the Netherlands, and a large share of the pollution results from the production and use of pharmaceuticals. A large amount of medication distributed to patients admitted at Isala Zwolle remains unused and is unnecessarily disposed of. In this research, this unused medication is redistributed, while remaining cost-efficient and maintaining patient safety levels. Prior to piloting medication redistribution in practice, a Healthcare Failure Modes and Effects Analysis is performed to determine the risks of redistributing medication. The identified risks are mitigated via double verification of medication by pharmacy assistants and nurses. Moreover, the cost-efficiency of redistributing unused medication is determined through modelling and solving a knapsack problem restricted by time. The model maximises the total returns or the total savings, while keeping the time effort within given bounds. The model outcomes show that the majority of medication can be returned within 15 minutes, while remaining cost-efficient. After a successful prospective assessment of medication redistribution, we verify the effects of medication redistribution on waste reduction in practice through a 2-month pilot in Isala Zwolle. In the pilot, unused medication is placed in return boxes and is distributed again in the next round of patient medication distribution. During and after the pilot, we measure the cost-savings, time efficiency, waste reduction, and experience of involved professionals. The results show that within 15 additional minutes per weekday, an average of 75% (interval: 49%-84%) of medication returned to KF can be redistributed and prevented from being disposed of. The average savings when allowing for these 15 additional minutes are on average €208 to €279 per week (interval: €66-€1,258). Eight of the thirteen pharmacy assistants agree that redistributing medication requires 15 additional minutes per day. Concluding, without additional funding or increased staffing levels, Isala Zwolle can safely and cost-efficiently redistribute more than 6,000 unused medication units per week when expanding the pilot to all wards. A waste reduction of 84% or more is possible when using the return boxes and returning all usable medication, regardless of the time limit.
Item Type:Essay (Master)
Isala, Zwolle, The Netherlands
Faculty:BMS: Behavioural, Management and Social Sciences
Programme:Industrial Engineering and Management MSc (60029)
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