CTU Medication

Management
Decreasing pharmacy
expenses on a critical care unit

Lindsay Vasquez RN CCRN

Project Overview
On the acuity adaptable cardiothoracic unit where I work

there is a lot of IV medication consumption by our patients.

Concern from pharmacy and management was raised

about the amount of unused or expired medications being

left in the nurse medication drawers.
There needed to be a better process in place to hold staff

accountable for returning medications in a timely manner.

Through data collection

and education, the

expenses incurred from
improper medication
management were
reduced and improved
practices were
introduced and adopted.

Cost Savings

The topic was old, but needed new

attention

It is not uncommon to hear in unit huddles or meetings

that we need to start cutting costs, whether it be in

staffing hours or supply costs. Even though our census
continues to stay high, we had to face the fact that
reimbursement is decreasing and becoming more pay
for performance.
Pharmaceuticals are one of the largest expenditures for a

hospital and nursing can have direct impact on this cost.

Historically, the pharmacy department represents one of
a hospitals highest cost centers (Blackmere, 2012).
To advocate successfully for the resources needed to

staff and operate their units, nurses need to become

more financially savvy and increase their understanding
of healthcare costs (Sherman & Bishop, 2012).

Project Goals
Provide thorough, formal education to nursing
staff on pharmacy expenses for both patients
and the organization as a whole in order to
improve the medication management and
resource allocation on our cardiothoracic unit
and decrease expenses for patients and the
pharmacy department by November 16,
2015. The collection of data at the beginning
and ending of the project will demonstrate
marked improvement in the pharmacy
expenses on the unit by November 16, 2015.

Objectives
1. Review current literature on medication/pharmacy

expenditures in the inpatient setting and solutions to

these situations in other organizations.
2. Establish project team members and contacts.
3. Obtain baseline data on A2 medication management.
4. Educate on the cost of medications commonly used on

A2 and the impact these expenses have on the patient

and the hospital.
5. Create an electronic task in Powerchart or, if not

possible, a visual reminder to return medications to

pharmacy.
6. Educate on new actions and processes to be put in

place to improve compliance with responsible

medication management.
7. Obtain follow-up data marking the progress of

medication management on A2.

2500

The results were not

terrible, but there was
definitely room for
improvement
12000
Cost to the
Patient

Cost to the Hospital 10000

2000

8000
1500

8128.95
6000

2176.31
1000
500
0

1303.56

4000
2000

155.68
107.81
96.12
93.88 136.68

5112.25

1493.05
942.3651.8
755.25

863.05

Quality and Safety

Being good stewards with patients

medications saves the hospital, and more

importantly, the patients a lot of money.
Patients are already taxed with their

stressful health conditions and showing

responsibility in our medication
management can alleviate some more
undue strain.
With declining healthcare reimbursement

and growing numbers of patients unable to

pay for their health care, nurses are
expected to do more with less. Meeting this
challenge will take innovative thinking and
involvement of all staff. The business of
caring is perhaps more important today
than ever. Your involvement, interest, and
support can help ensure patients receive
high-quality care, and can go a long way
toward promoting your organizations
healthy financial future (Sherman &
Bishop, 2012).

Process

The project management process was the key to the success of my

project.
The Project Scope and Plan gave me a framework to follow.

Breaking down the deliverables into activities makes the project

managers job easier, because the work is subdivided into small
units that are easily assigned to one team member or a group of
team members (Heldman, 2011).

Progress
Progress of the success of the project was measured with the

follow-up collected near the end of the project. The amount of

waste was considerably improved and nurses understood the
importance of proper medication management.
This project stimulated modifications in the forumulary of our

expensive Nitroprusside drips and the distribution of insulin pens.

These projects will further develop over the next couple months.

Completion
There was a lot of pride in completing the

project, knowing I accomplished

something that will have a direct patient
impact.

Ethical/Professional
The biggest ethicalIssues
issue that this project addressed
was the ethical principle of justice.

The fourth ethical principle, justice, means giving

each person or group what he/she or they are due. It

can be measured in terms of fairness, equality,
need or any other criterion that is material to the
justice decision. In nursing, justice often focuses on
equitable access to care and on equitable scarce
resource allocation (Silva & Ludwick, 1999).
Communication was one of the biggest professional

issues that arose during this project.

The best resolution was to meet with team members

in person to thoroughly work through these issues.

Lessons Learned
Being a good leader requires patience,

persistence, and adaptability.

It takes time and effort to gain acceptance of

any change or new idea.

It is essential to be open to opinions and

varying viewpoints.
Collaborative Leadership as
defined by Ferris State
University (2011) states,
Assume a leadership role
within a health care or
community based care setting
to promote a culture of quality
and safety.

References

Blackmere, J. (2012). 7 steps to reduce hospital pharmacy costs

without eliminating staff. Retrieved from http://
www.beckershospitalreview.com/hospital- managementadministration/7-steps-to-reduce-hospital- pharmacy-costs-withouteliminating-staff.html
Ferris State University. (2011). BSN Program Outcomes. Retrieved
http://www.ferris.edu/colleges/alliedhe/nursing/BSN- programoutcomes.htm

from

Heldman, K. (2011). Project Management Jump Start. Wiley Publishing;

Indianapolis, Indiana.
Sherman, R. & Bishop, M. (2012). The business of caring: What every
nurse should know about cutting costs. American Nurse Today, 7(11).
Silva, M. C. & Ludwick, R. (1999). Ethics: Interstate Nursing Practice
and Regulation: ethical issues for the 21 st century. Online
Journal of
Issues in Nursing, 4(2). Retrieved from http://
www.nursingworld.org/MainMenuCategories/
ANAMarketplace/ANAPeriodicals/OJIN/Columns/Ethics/
InterstateNursingPracticeandRegulation.html