Minimizing Medication Waste during the Coronavirus-19 Global Pandemic

The joint statement on minimizing waste during the Coronovirus Global Pandemic is also available for download (PDF)

The surge in COVID-19 patients requiring acute medical care has resulted in shortages of some medications critical to their care. Institutions must balance the preservation of scarce resources with the risk of exposure from possible sources of contamination. In some cases, this may include deciding whether to discard unused and unopened medications that might be contaminated with the SARS-CoV-2 virus to prevent spread of the infection to patients and healthcare workers. These decisions are even more critical given the nationwide shortage of medications needed for intubation and mechanical ventilation of COVID-19 patients. Wasting medications in critically short supply should be avoided unless absolutely necessary. Without preferred agents, practitioners may be required to use medications with which they are unfamiliar, that are less effective, or that have more side effects, thereby introducing patient safety risks.

The following statements summarize our joint recommendations for minimizing medication waste during COVID-19:

• Infection Prevention and Control – Do not discard unused and unopened medications, especially those in short supply, without considering options for isolation, disinfection, and segregation. Protect medications from contamination by keeping them out of patient rooms unless necessary. When possible, place medications in zip-lip baggies to protect them from contamination until the point of use. Unused medications that have been exposed to SARS-CoV-2 may be decontaminated with an EPA-registered disinfectant that is qualified under the viral pathogens program using appropriate dwell times, or they may be segregated from unaffected inventory until sufficient time has passed to deem them decontaminated.^1,2
• Medication storage policies – Our organizations also support other means of waste prevention for medications critical to the treatment of COVID-19 patients. We advocate for the use of primary literature to support extended dating beyond the list in FDA-approved manufacturer labeling. Regulators should adopt policies that allow the use of evidence-based stability data to prevent waste of medications.
• Beyond-use dating and compounding medications – The United States Pharmacopeia Compounding Expert Committee developed a resource with considerations for sterile compounding and beyond-use dates to prevent the waste of drugs in short supply.3 These considerations include longer storage times at room temperature than the currently official version of Chapter <797> Pharmaceutical Compounding – Sterile Preparations. Hospitals should review these considerations and consider how they may be applied to prevent waste of compounded preparations of drugs in shortage during the COVID-19 pandemic.  In addition, the FDA has issued guidance that during the COVID-19 public health emergency, outsourcing facilities and pharmacy compounders not registered as outsourcing facilities have flexibilities to compound several needed drugs if the drugs are in shortage and will be used to treat hospitalized patients with COVID-19.^4,5

Wasting of medications during this time of increased demand and supply chain disruption due to COVID-19 must be minimized. These recommendations outline strategies for stewarding critically important medications.

References:

1. Centers for Disease Control and Prevention. Infection control recommendations: Environmental infection control (Accessed April 19, 2020)
2. Environmental Protection Agency. List N: Disinfectants for use against SARS-CoV-2 (Accessed April 19, 2020)
3. United States Pharmacopeial Convention Inc. Operational considerations for sterile compounding during COVID-19 pandemic (Accessed April 19, 2020)
4. Food and Drug Administration. Temporary policy for compounding of certain drugs for hospitalized patients by outsourcing facilities during the COVID-19 public health emergency (Accessed April 21, 2020)
5. Food and Drug Administration. Temporary policy for compounding certain drugs for hospitalized patients by pharmacy compounders not registered as outsourcing facilities during the COVID-19 public health emergency (Accessed April 21, 2020)

Additional Resources:
ASHP Drug Shortages Database
ASHP Guidelines on Managing Drug Product Shortages
FDA Drug Shortages Database

About ASA: Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 54,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists.

About ASHP (American Society of Health-System Pharmacists): ASHP represents pharmacists who serve as patient care providers in acute and ambulatory settings. The organization’s over 55,000 members include pharmacists, student pharmacists, and pharmacy technicians. For more than 75 years, ASHP has been at the forefront of efforts to improve medication use and enhance patient safety. Visit ASHP.  Access our COVID-19 Resource Center.