Discarded intravenous medication in the ICU: the GAME-OVER multicenter prospective observational study
Erwan d’Aranda, for the GAME-OVER investigators group, Paër-Sélim Abback, Pierre Albaladejo, Adrien Auvet, Enora Atchade, Julio Badie, Baptiste Balanca, Fernando Daniel Berdaguer Ferrari, Fanny Berenguer, Fanny Bernard, Rémy Bernard, Rudy Berthezene, Anne Bignon, Pauline Bleuze, Laure Bonnet, Yvonnick Boue, Boris Boulanger, Guillaume Boulay, Marie Boulo, Fanny Vardon‐Bounes, Pierre Bouzat, Jean-François Carabalona, Dimitri Ceausu, Claire Chabre, Véronique Chaillet, David Charriere, Riad Chelha, Noémie Clavieras, Marion Costecalde, Pierre Couhault, Jullien Crozon-Clauzel, Erwan d’Aranda, Sophie Debord-Peguet, Hugues de Courson, Mathilde Delage, Agathe Delbove, Olivier Desebbe, Olivier Duranteau, Sébastien Ehrminger, Djilali Elaroussi, Vedat Eljezi, Brice Fermier, Camille Foucault, Sylvain Garnier, Camille Gaydon-Serres, Cyrille Geay, Marie Geslain, Fanny Giannoni, Clarisse Gierczak, Emmanuelle Guigal, Mathieu Guilbart, Jérémie Guillemin, Emmanuelle Hammad, Clément Hoffmann, Edith Hourcastagnou, Emmanuelle Jaillette, Marie Jan, Toufik Kamel, Agathe Kudela, Francoise Labat, Marc Laffon, Thomas Lancry, Sigismond Lasocki, Yoann Launey, Grégoire Le Gac, Vincent Legros, Yann Le Guen, Quentin Levrat, Amaury Lhermitte, Clément Magand, Stéphanie Malaquin, Charlotte Martin, Olivier Martin, Gabriel Masson, Yannick Masson, Nicolas Mayeur, Anthony Merlin, Abolfazl Mohebbi-Amoli, Martin Mombrun, Jean-François Parizano, Cyril Pernod, Fanny Planquart, Gaëtan Plantefeve, Quentin Ressaire, Faustine Reynaud, Clothilde Schilte, Mathieu Schoeffler, Johan Schmitt, Géraldine Selly, Arnaud Sement, Benjamin Soyer, Emanuele Turbil, Jean Turc, David Vandroux, Antoine Villecheze, Hadrien Winiszewski, Stéphanie Pons, Jonathan Chelly, Enora Atchade
Abstract
BACKGROUND: Medication waste is a contributor to the healthcare environmental footprint and impacts ecosystems. Data on medication waste in the intensive care unit (ICU) are scarce, and therefore are essential to develop new sustainable strategies. METHODS: The GAME-OVER French multicenter prospective observational study was conducted from November 2022 to March 2023, over a 24-h period of choice, at the discretion of each participating center. Adult ICUs were enrolled in the study on a voluntary basis and hospitalized patients who did not express opposition were included in the analysis. The primary endpoint was the percentage of discarded intravenous (IV) medication in the ICU, defined as the ratio of the discarded volume to the total volume of IV medication prepared. Secondary endpoints included identifying risk factors and main reasons for medication waste and estimating its related healthcare cost. RESULTS: Among the 81 ICUs and the 1076 enrolled patients, 408.9 L of 130 IV medications were prepared. The discarded volume was 43.8 L, resulting in a 10.7% discarded IV medication (95% Confidence Interval (CI), 9.9-11.5). Number of daily admissions/discharges in the ICU, as admission for elective surgery, Sequential Organ Failure Assessment score ≥ 7, endotracheal intubation, renal replacement therapy and body mass index were independently associated with increased discarded IV medication. Ninety percent of pharmaceutical waste was attributed to 25 key drugs, with an estimated national annual cost of 2,737,163€. CONCLUSIONS: Discarded intravenous medication in the ICU is considerable and results in significant costs for the health care system, without obvious patient-centered value. Risk factors associated with medication waste were largely nonmodifiable, emphasizing the need for sustainable practices in patient care and resource management. TRIAL REGISTRATION: ClinicalTrials.gov: NCT05553054 . September 23, 2022.