Transcript Poster template - UCLA Simulation Center

Cory Soto, B.S., Jamie Stiner, Rukhsana Khan, M.P.H., Daniel Noji, B.S., and Jeffrey Rusheen, M.D.
700 Westwood Plaza, Suite A222 LRC, Los Angeles, CA 90095
The Problem
Production
• Borosilicate serum vials in 2 mL, 5 mL, 10 mL
and 20 mL volumes covered much of the needed
drugs for simulation.
Facilities that offer high fidelity experiential training have
been able to integrate increasingly realistic settings,
confederate actors and medical devices into their simulations.
However, the availability and utilization of drugs and other
pharmaceuticals have lagged behind for several reasons:
•Expired medications may, depending upon State law, require
“reverse distributor”1 licensure and keeping in-date drug may
require tight record keeping, vault storage and auditing by
Boards of Pharmacy.2
•In-date and expired medications are safety hazards for
participants and staff. They also contaminate simulation
equipment and require strict adherence to proper disposal of
pharmaceutical waste.3
•Commercial simulated drugs are expensive and limited in the
variety available.
13 mm
stopper (left)
and flip-off
cap (right)
• The outside diameter, or O.D., is a measurement taken at the mouth of
the vial. The 2 mL vial has a 13 mm O.D. while the 5 mL, 10 mL and 20
mL all have 20 mm O.D.
• Make sure measurements match the vial, stopper, cap and crimper as
there are more varieties of O.D. than the ones listed!
• The contents of the vials were standardized to be a 0.9% NaCl solution
taken from IV bags.
2. Are there any injectable drugs you would like
specifically created for your simulations? (If so, please
include concentration and volume)
Responses were collected and the most frequently requested
items were included in the initial production queue to guide
the choice of equipment and supplies to purchase.
• Labor costs were calculated for an entry-level simulation
specialist at $20/hr and for a non-simulation specialist (part-time
work-study student) at $14/hr. A total of 26 hours were allotted
for the production of 500 vials.
Stopper insertion
(left) and placement
of cap (right)
Crimper mounted on vial
assembly
• The stopper fits into the neck of the vial, the flip-off cap slides snugly
over the stopper and the crimper envelops the assembly to seal the foil of
the cap.
• Labels for the simulated
drugs were designed to
clearly state they are not
for use on humans.
Sealed vial (left)
and simulated
drug labels (right)
• Precautions were taken to
add a large bolded
“SIMULATED” above
each drug name and “For
simulation only. Not for
human consumption”
where the expiration of the
drug would be checked.
Production based upon the needs assessment resulted in the
creation of 33 different simulated pharmaceuticals, with more
in development.
•The simulated drugs are stored in various locations including
crash carts, anesthesia carts and in our simulated pharmacy.
•When new drugs are needed for cases, we utilize an online
label creation program (SOPHIE TM) to produce labels that
can be affixed to prefilled vials to minimize turnaround.
Total Cost Per Vial Made
Vial Total Material Cost Total Tech Labor Total Non-Tech Labor
2 mL
$0.45
$1.40
$0.73
5 mL
$0.53
$1.40
$0.73
10 mL
$0.63
$1.40
$0.73
20 mL
$0.73
$1.40
$0.73
Tech Vial Cost
$1.85
$1.93
$2.03
$2.13
Non-Tech Vial Cost
$1.18
$1.26
$1.36
$1.46
• Vials produced by a non-technician are cheaper than
commercially available options.
3. Do you have any suggestions for injectable drugs that
may be useful for simulation, in general? (If so, please
include concentration and volume)
4. Do you know of any colleagues who would be interested
in pharmaceutical simulation or integrating simulated
pharmaceuticals into their teaching at the Simulation
Center? If so, please provide their name and I will contact
them.
• Material costs were calculated by adding the price per unit for the
vial, stopper, flip-off cap, contents, labels and syringes.
Vial Commercial Cost
2 mL
$1.32
5 mL
$1.50
10 mL
$1.74
20 mL
$2.75
Assessing Specific Needs
1. Do you see a need for simulated medications to enhance
realism and learning during the scenarios?
The true cost of a simulated drug vial was derived from two parts:
2 mL Vial
The safest and most cost effective means of meeting the need
for simulated drugs is to produce them yourself!
A survey was sent to each simulation facilitator soliciting
requests for items that would be valuable in their individual
program.
Integration
Cost Analysis
Total Yearly Cost Using In-House Simulated Drugs Versus
Commercial Drugs for Anesthesia Residents
Vials
Commercial
Vial Type Assembled
Cost
2 mL
100
$132.00
5 mL
50
$75.00
10 mL
75
$130.50
20 mL
25
$68.75
Total
500
$406.25
Tech
Made
$185.00
$96.50
$152.25
$53.25
$487.00
Non-Tech
Made
$118.00
$63.00
$102.00
$36.50
$319.50
The flexibility and cost-efficiency of this simulated
pharmaceutical program have enabled us to readily respond to
impromptu and unexpected needs that comes with simulation.
References
1. United States Justice Department, Drug Enforcement Administration. Web Site.
http://www.deadiversion.usdoj.gov/fed_regs/rules/2005/fr0502.htm. Accessed July 17,
2013.
2. California State Board of Pharmacy Business & Professions Code Chapter 9,
Division 2, Article 2, Section 4031. Web Site.
http://www.pharmacy.ca.gov/laws_regs/lawbook.pdf. Accessed July 16, 2013.
3. United States Environmental Protection Agency. Web Site.
http://www.epa.gov/waste/hazard/generation/labwaste/rule.htm. Accessed July 15,
2013.
Acknowledgments
We thank the faculty of the UCLA Simulation Center for their
help in selecting drugs for simulation and for their
encouragement of our work.
Special thanks to Yue Ming Huang, Ed.D and Randolph
Steadman, M.D. for their advice and mentoring during the
planning, production and implementation of the program.
Assumption: A year’s worth of simulated drug for Anesthesia residents is based upon 3 vials of simulated
drug used during each simulation, 3 simulations per Wednesday, 4 Wednesdays per Month, 12 months per
year which equals 432 vials with 68 vials as a buffer in case more are needed throughout the year.
Total Yearly Cost Using In-House Simulated Drugs Versus
Commercial Drugs for a Class of 60 Nursing Students
Vial Vial Count Commercial Cost Tech Made Non-Tech Made
10 mL
720
$1,252.80
$1,461.60
$979.20
Assumption: A nursing program with 60 students learning how to draw medications for intravenous
administration. Each uses three 10 mL vials of 0.9% NaCl at each practice session. There are four sessions
per year.
Further Information
Any questions or comments regarding the material
presented can be directed to the team at:
E-mail: [email protected]
Visit our website at:
www.sim.ucla.edu