Ready-to-Use Versus Traditional IV Piggyback Preparation: A Combined Process-Error, Workforce-Time-Waste, and Cost-Effectiveness Analysis

Background: Manual IV medication preparation requires multiple discrete steps, each a potential point of process deviation, while manufacturer-prepared ready-to-use (MP-RTU) products avoid many manual compounding steps. The peer-reviewed literature describing and quantifying real-world process-error and workforce-time-waste (WTW) differences between traditional IV piggyback (IVPB) and MP-RTU products remains limited. Methods: Two complementary studies were conducted. The Alpha study was a prospective, direct-observation study of 100 micafungin (47 steps) and 100 norepinephrine (15 steps) preparations at a 541-bed hospital. The Bravo study was a retrospective operational analysis of utilization, request burden, time to administration, and preparation cost for four medications at a 615-bed hospital. The results informed a decision-analytic cost-effectiveness model (1-year horizon, health-system perspective) comparing MP-RTU with IVPB, with sensitivity analyses. Results: Micafungin preparations contained 208 process errors (4.4%; 67% with ≥1 error), concentrated in drug withdrawal, syringe assembly, and material collection; norepinephrine preparations contained 100 errors (6.7%; 70% with ≥1 error), concentrated in hood preparation/compounding. Pharmacy-prepared insulin and vasopressin showed higher request burden and roughly 2 h longer time to administration than MP-RTU equivalents. MP-RTU dominated IVPB in the model, with a base-case incremental cost-effectiveness ratio of −$4954.15 per additional error avoided, robust across sensitivity analyses. Conclusions: Manual IV preparation introduced process error and operational burden that was either reduced or absent with MP-RTU; this was also less costly and more effective in the model. The findings support considering process-error opportunity and operational burden, not acquisition cost alone, when evaluating IV medication-preparation strategies.