BLOG: Use those drops again
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We shrug our shoulders. We roll our eyes. We think, “What’s the use?” Those of us in the medical field have become painfully accustomed to seeing waste in caring for patients.
A 2020 study showed that health care contributes almost 10% of the total greenhouse gas emissions of our country, and we’re the second largest contributor to landfill trash. Furthermore, operating rooms make up about a third of this waste.
We in ophthalmology share no small part of the blame for this because we perform more surgery than most other specialties. Although our target organ is small, our contribution to waste is large. There are many ways we can reduce our impact, and one that every institution should pursue is the reuse of eye drops for multiple patients.
Drs. David Palmer and Alan Robin brilliantly composed a position paper on this topic that has been supported by the American Society of Cataract and Refractive Surgery, the American Academy of Ophthalmology, the American Glaucoma Society and the Outpatient Ophthalmic Surgery Society (OOSS). In the paper, which was a work product of the Ophthalmic Instrument Cleaning and Sterilization (OICS) Task Force chaired by David Chang and Cathy McCabe, David and Alan make three recommendations that every eye care facility should heed.
First, with adherence to proper guidelines, eye drops in multidose containers can be used on multiple patients in surgical facilities, including hospitals. Among other sources, they cite a 2021 study showing in 1,800 patients that multi-patient use of multidose containers did not result in any microbiologic contamination or increased risk for endophthalmitis. This is no surprise to most ASCs, where reuse of bottles is fairly common; hospitals are the main culprit here.
You say your facility has been told by The Joint Commission (TJC) to throw away bottles after single-patient use? The position paper cites examples of facilities that have appealed and overturned the wasteful (and unfunded) mandate, citing AAO guidelines that are referenced in the paper.
Second, the paper provides evidence that drugs in multidose containers can continue to be used until their date of expiration. According to a 2021 OOSS survey, the majority of ASCs discard drops within 30 days of first use. But direct guidance from the leadership of the FDA, TJC, CDC and American Association for Accreditation of Ambulatory Surgery Facilities have all agreed that if aseptic standards are followed, eye drops may be used until they expire, regardless of when they were opened.
Finally, the paper gives guidance that patients should be able to bring home their partially used medications for use after surgery. In cases in which a patient requires a unique product in a multidose container that will not be used for other patients, it is not necessary for the patient to get a separate prescription for that same product at a pharmacy. Local rules may require dosing instructions to be added to take-home bottles, and other rules may exist, but it is wasteful and medically unnecessary to throw these bottles away after just a dose or two.
It may be challenging to convince administrators at local facilities to alter the long held but wasteful practice of throwing away bottles of eye drops, but the benefits are economic, too. According to the position paper, a 2019 study published in JAMA Ophthalmology evaluating four cataract surgery facilities estimated the cost of throwing away drops to be $150 per case or $195,000 per year per facility. How’d you like to add that to your bottom line?
What I liked best about this position paper, and indeed all the efforts EyeSustain is making, is the feeling of empowerment that we can overcome regulatory and administrative barriers to reducing waste. No more shrugging our shoulders. Let’s get to work!
References:
- Reducing topical drug waste in ophthalmic surgery: Multisociety position paper. https://eyesustain.org/-/media/eyesustain/pdfs/topical-drug-position-statement.pdf. Accessed Dec. 15, 2022.
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