Assessing Pharmacy Costs of Intravenous Push Controlled Substance Waste in Hospital-Based Areas: A Multi-Site Study

Intravenous push (IVP) administration of controlled substances in hospital settings presents operational challenges related to medication waste, documentation, and diversion risk. This multi-site observational study aimed to quantify the pharmacy workforce time and associated costs linked to IVP waste management across a 16-hospital health system in Southwest Florida. Data were collected from over 4400 controlled substance transactions involving fentanyl, midazolam, hydromorphone, morphine, ketamine, and lorazepam. Methods included automated transaction analysis, manual chart reviews, and software-based compliance case evaluations. Results indicated patterns of partial dose waste, particularly for midazolam (85.2%) and hydromorphone (78.8%), and identified opportunities where documentation efforts could be further optimized through automation. Manual review of 333 incidents required an average of 6 min and 43 s per case, extrapolating to over 496 h of quarterly pharmacy labor or nearly 1985 h annually. Software-based case reviews added another 32 h per quarter or 130 h annually. Additionally, waste receptacle systems incurred over USD 1.1 million in capital costs and USD 322,500 in annual maintenance, with technician labor contributing further operational burden. These findings underscore the resource demands of IVP waste management and support the need for standardized dosing, enhanced documentation workflows, and pharmacy-led interventions to improve efficiency and reduce diversion risk.