Minimizing surfactant wastage on transport

Background: Surfactant replacement therapy decreases pulmonary morbidity and mortality in premature infants with respiratory distress syndrome. It may also benefit patients with conditions associated with surfactant inactivation and secondary dysfunction, such as acute respiratory distress syndrome. Specialty Neonatal and Pediatric Transport Teams often carry surfactant when the patient condition potentially warrants administration. Because surfactant replacement therapy is costly, proper storage and handling is essential to minimize wastage. Without a process in place to maintain proper refrigeration of surfactant on transport, all vials of surfactant were discarded after our Transport Team returned their medications to the pharmacy. A pharmacy audit revealed that an average of 25-30 vials were wasted per month between January-June 2016 (estimated loss of $9k-$11k/month), prompting the following quality improvement project. AIM Statement We aim to decrease surfactant vial wastage on transport by 60% within the next 24 months by implementing a new process to track warmed surfactant vials after they are returned to the pharmacy and minimize warming of surfactant on transports. Methods A multidisciplinary team (RN, RT, MD, management, pharmacist) was assembled to brainstorm how best to address surfactant wastage. Following review of the manufacturer's package insert, a new labeling/tracking system was implemented to identify vials that had been warmed once and returned to inventory. Process mapping of the current process for taking surfactant on transport helped to identify potential barriers to process change in the context of existing Transport Team workflow. Use of a cooler to maintain refrigeration of surfactant on transport was then proposed. Numerous tests of change (Plan-do-study-act cycles) were performed to refine the type of cooler used, packaging details, and medication request process. Finally, a new algorithm for restocking surfactant to general inventory (if returned within recommended storage temperatures) vs. NICU inventory (if returned warmed once) was implemented to further minimize waste. Results Early audit of surfactant temperatures following transport using a cooler revealed that 100% of vials returned within the manufacturer's recommended storage temperature range (data not shown). Over the past 21 months, surfactant wastage has decreased from 100% in the baseline data collection period to 9.6% during project year 1 and 2.8% during pro