NEWS & OPINION EWAP SEPTEMBER 2022 61 by David F. Chang, MD Contact information Chang: dceye@earthlink.net Multisociety OICS Task Force issues recommendations on reducing topical drug waste in ophthalmic surgery T he Ophthalmic Instrument Cleaning & Sterilization (OICS) Task Force is comprised of representatives from the American Society of Cataract and Refractive Surgery (ASCRS), the American Academy of Ophthalmology (AAO), the American Glaucoma Society (AGS), and the Outpatient Ophthalmic Surgery Society (OOSS), and previously developed ophthalmology- specific guidelines for surgical instrument processing and sterilization.1 Co-chaired by Cathleen McCabe, MD, and myself, the Task Force is also focused on reducing operating room waste, which significantly increases the cost and carbon footprint of ophthalmic surgery. In a 2020 survey by the OICS Task Force, 93% of ophthalmologists thought that operating room waste was excessive.2 Almost all (98%) were using or were willing to consider using multidose bottles of topical medication for multiple cataract patients. However, less than half were using multidose bottles for topical anesthetic (43%), mydriatics (48%), NSAIDs (38%), and antibiotics (45%). In a subseµuent sub-analysis, those using multidose bottles on multiple patients were much more likely to be operating in ambulatory surgery centers (ASCs) than in hospital outpatient departments (52% vs. 19% using multidose mydriatic drops).3 A separate survey of OOSS member ASCs was conducted by the OICS Task Force in 2021. Most ASCs were using multidose bottles on multiple patients, but only 12% said they continued utilizing them until the labeled expiration date; others were discarding the bottles at the end of the day (9%), the week (3%), or the month (72%). These two surveys revealed wide variation in whether multidose bottles are reused on multiple surgical patients, and if so, for how long. This is important because surgical drugs account for a significant proportion of cataract surgery’s cost and carbon footprint. A 2019 study analyzed the economic and environmental impact of medication waste at four cataract surgical facilities.4 Based on their analysis, the researchers projected that drug waste costs approximately US$150 per case and generated 23,000 to 105,000 metric tons of unnecessary CO2 eµuivalent emissions annually in the U.S. An OICS subcommittee led by David Palmer, MD, and Alan Robin, MD, researched the regulations regarding multidose bottles by contacting multiple agencies, including The Joint Commission, the Accreditation Association for Ambulatory Health Care, the American Association for Accreditation of Ambulatory Surgery Facilities, the Centers for Disease Control and Prevention, the U.S. Food and Drug Administration (FDA), and the Centers for Medicaid & Medicare Services (CMS). Following discussions with the Task Force, Wiley Chambers, MD, director of the FDA Office of Specialty Medicine, Division of Ophthalmology, wrote a supportive editorial on reducing drug waste.5 These agencies were consistent in permitting surgical facilities to use topical drugs in multidose containers on multiple patients until the manufacturer’s labeled date of expiration, assuming that proper guidelines are followed. The OI S Task Force specifically asked CMS to clarify to its surveyors that multidose eye drop bottles are not subject to the 28-day expiration policy that applies to injectable solutions. As part of their collaboration with our Task Force, the American Society of Ophthalmic Registered Nurses (ASORN) published an updated multidose eye drop application protocol on its website.6 Dr. Palmer previously led efforts to enact legislation in Illinois to enable surgical patients to bring partially used topical medication home for postoperative use, when appropriate. In 2021, the American Medical Association House of Delegates unanimously adopted a modification of the Illinois resolution titled “Permitting the Dispensing of Stock Medications for PostDischarge Use and the Safe Use of Multidose Eyedrops on Multiple patients,” which had been endorsed by multiple specialty societies, including AAO, ASCRS, AGS, and ASORN. The OICS Task Force distilled its research into a This article originally appeared in the June 2022 issue of EyeWorld. It has been slightly modified and appears here with permission from the ASCRS Ophthalmic Services Corp.
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