{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:43:01Z","timestamp":1773758581971,"version":"3.50.1"},"reference-count":8,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T00:00:00Z","timestamp":1773100800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>A previous project was completed to evaluate the opportunity to standardize and optimize epidural use at the UNC Medical Center. VERB (vial, exchange, rate, and bag) analysis was applied to identify preparations optimized for efficient supply and resource utilization. Converting a hydromorphone\/bupivacaine epidural preparation from a total bag volume of 250\u2005mL to 100\u2005mL was proposed for a pilot study. The primary objective of this implementation study was to assess the operational impacts on drug and fluid utilization and waste.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A quasi-experimental, single-center pilot implementation study was conducted at a large academic medical center. The proposed volume change was piloted in 2 units for a duration of 6 months. Data from various sources were collected, including administration data documented in the electronic health record and epidural infusion pumps and dispense and waste data from automated dispensing cabinets. Outcomes assessed included the total drug volume infused, the total waste accumulated per encounter, the number of nursing bag exchanges per encounter, and nursing and pharmacy staff satisfaction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Implementation of the 100-mL hydromorphone\/bupivacaine epidural preparation resulted in a notable decrease in waste during the compounding and administration process. Nursing bag exchanges occurred at a higher rate than hypothesized per 48-hour period. Storing the epidural medication on the units allowed for timely administration and bag exchanges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Storing epidurals at the site of care in automated dispensing cabinets increased nursing satisfaction, but the increased rate of bag exchanges remained a concern. Estimated decreases in drug and fluid waste should be noted for future hospital-wide implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ajhp\/zxag069","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T12:38:19Z","timestamp":1773146299000},"source":"Crossref","is-referenced-by-count":0,"title":["Implementation of optimized epidurals in the anesthesiology pain service at UNC Medical Center: A pilot study"],"prefix":"10.1093","author":[{"given":"Shirly","family":"Ly","sequence":"first","affiliation":[{"name":"UNC Medical Center , Chapel Hill, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen F","family":"Eckel","sequence":"additional","affiliation":[{"name":"UNC Eshelman School of Pharmacy , Chapel Hill, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathrine","family":"Donnowitz","sequence":"additional","affiliation":[{"name":"UNC Health , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felicia","family":"Britt","sequence":"additional","affiliation":[{"name":"Duke University Heath System , Durham, NC ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2026,3,10]]},"reference":[{"key":"2026031708165783000_zxag069-B1"},{"issue":"18","key":"2026031708165783000_zxag069-B2","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1093\/ajhp\/zxaa199","article-title":"Using intravenous pump infusion data to optimize continuous infusion concentrations and reduce drug and fluid waste","volume":"77","author":"Forshay","year":"2020","journal-title":"Am J Health-Syst Pharm"},{"key":"2026031708165783000_zxag069-B3","doi-asserted-by":"publisher","first-page":"l4185","DOI":"10.1136\/bmj.l4185","article-title":"Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis","volume":"366","author":"Panagioti","year":"2019","journal-title":"BMJ"},{"issue":"12","key":"2026031708165783000_zxag069-B4","doi-asserted-by":"crossref","first-page":"e015912","DOI":"10.1136\/bmjopen-2017-015912","article-title":"Systematic evidence review of rates and burden of harm of intravenous admixture drug preparation errors in healthcare settings","volume":"7","author":"Hedlund","year":"2017","journal-title":"BMJ Open"},{"issue":"1","key":"2026031708165783000_zxag069-B5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1136\/ejhpharm-2018-001624","article-title":"Incidence and prevalence of intravenous medication errors in the UK: a systematic review","volume":"27","author":"Sutherland","year":"2020","journal-title":"Eur J Hosp Pharm"},{"issue":"suppl 3","key":"2026031708165783000_zxag069-B6","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1097\/00000446-200503001-00006","article-title":"Toward safer IV medication administration: the narrow safety margins of many IV medications make this route particularly dangerous","volume":"105","author":"Nicholas","year":"2005","journal-title":"Am J Nurs"},{"issue":"22","key":"2026031708165783000_zxag069-B7","doi-asserted-by":"publisher","first-page":"2176","DOI":"10.2146\/ajhp110001","article-title":"Standardizing i.v. infusion concentrations: national survey results","volume":"68","author":"Phillips","year":"2011","journal-title":"Am J Health-Syst Pharm"},{"issue":"19","key":"2026031708165783000_zxag069-B8","doi-asserted-by":"publisher","first-page":"e611","DOI":"10.1093\/ajhp\/zxae057","article-title":"Development of optimized adult epidural infusion preparations to reduce waste and improve operational efficiency","volume":"81","author":"Donnowitz","year":"2024","journal-title":"Am J Health-Syst Pharm"}],"container-title":["American Journal of Health-System Pharmacy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag069\/67297673\/zxag069.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article-pdf\/doi\/10.1093\/ajhp\/zxag069\/67297673\/zxag069.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T12:17:01Z","timestamp":1773749821000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ajhp\/advance-article\/doi\/10.1093\/ajhp\/zxag069\/8513884"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,10]]},"references-count":8,"URL":"https:\/\/doi.org\/10.1093\/ajhp\/zxag069","relation":{},"ISSN":["1079-2082","1535-2900"],"issn-type":[{"value":"1079-2082","type":"print"},{"value":"1535-2900","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,10]]},"article-number":"zxag069"}}