How to Supply Your Drug Habit Creating Simulated

How to Supply Your Drug Habit Creating Simulated Pharmaceuticals from Laboratory Supplies 1 IMSH 2014 - Making Connections January 2014

Meet Our Team 2 Cory Soto, B. S. , CPh. T Simulation Specialist Daniel Noji, B. S. Programmer Analyst Simulation Specialist #IMSH 2014 Jamie Stiner Simulation Operations Manager Simulation Specialist Rukhsana Khan, M. P. H. Simulation Specialist Jeffrey Rusheen, M. D. Assistant Professor Anesthesiology

Disclosure(s) 3 We have nothing to disclose. Commercial vendors mentioned in this presentation are merely used as examples. We do not receive any compensation from them. #IMSH 2014 - Making Connections January 2014

Learning Objectives 4 Create a needs assessment to tailor the pharmaceutical production to your needs. Demonstrate how to produce vials for use as simulated drugs with hands-on instruction. Find ways to implement this new tool into your simulation center. #IMSH 2014 - Making Connections January 2014

Does your Simulation Center… 5 Use expired drugs? Buy commercially available simulated drugs? Make your own? #IMSH 2014 - Making Connections January 2014

6 The Problems #IMSH 2014 - Making Connections January 2014

A Solution: Do It Yourself! 7 #IMSH 2014 - Making Connections January 2014

Get The Right Tools for the Job 8 Outside Diameter, or O. D. Syringe Borosilicate Vial #IMSH 2014 0. 9% Na. Cl (Normal Saline) Table Salt IMSH 2014 - Making Connections January 2014

Get The Right Tools for the Job 9 Stopper Flip-Off Cap Crimper Flip-Off Cap #IMSH 2014 - Making Connections January 2014

Step One: Filling and Sealing 10 #IMSH 2014 - Making Connections January 2014

Step Two: Capping 11 #IMSH 2014 - Making Connections January 2014

Wow, That Was Easy! 12 #IMSH 2014 - Making Connections January 2014

Step Three: Crimping 13 #IMSH 2014 - Making Connections January 2014

The Assembled Vial 14 #IMSH 2014 - Making Connections January 2014

Now You Get To Do It! 15 #IMSH 2014 - Making Connections January 2014

Step Four: Labeling 16 #IMSH 2014 - Making Connections January 2014

Meet SOPHIE 17 q Simulated Online Pharmaceutical Image Editor q No need for expensive image editing suites q Developed by the UCLA Simulation Center for use by other Simulation Centers at no cost #IMSH 2014 - Making Connections January 2014

What Does Your Center Need to Maintain Their Drug Habit? 18 q. Common/Crash Cart Meds q. Medications for Rare Conditions (Dantrolene for Malignant Hyperthermia, Blood Factors, etc. ) #IMSH 2014 - Making Connections January 2014

Needs Assessment 19 Do you see a need for simulated medications to enhance realism and learning during the scenarios? Are there any injectable drugs you would like specifically created for your simulations? (If so, please include concentration and volume) Do you have any suggestions for injectable drugs that may be useful for simulation, in general? (If so, please include concentration and volume) Do you know of any colleagues who would be interested in pharmaceutical simulation or integrating simulated pharmaceuticals into their teaching at the Simulation Center? If so, please provide their name and I will contact them. #IMSH 2014 - Making Connections January 2014

Simulated Drugs Currently Available at UCLA 20 Adenosine Amiodarone Atropine Calcium chloride Dexamethasone Digoxin immune fab Diltiazem Diphenhydramine Famotidine Flumazenil Furosemide Glucagon Glycopyrrolate Heparin Hydralazine Insulin Midazolam Naloxone Neostigmine Nitroglycrin Norepinephrine Phenylephrine Propofol Rocuronium Dopamine Labetalol Succinylcholine Esmolol Etomidate Magnesium sulfate Metoclopramine Vasopressin Verapamil #IMSH 2014 - Making Connections January 2014

The Cost of Production 21 Material Cost Vials Cost 2 m. L $362. 78 5 m. L $213. 80 10 m. L $292. 20 20 m. L $297. 89 Subtotal $1, 166. 67 Stoppers 13 mm $77. 62 20 mm $120. 65 Subtotal $198. 27 Flip-Off Caps 13 mm $82. 24 20 mm $121. 27 Subtotal $203. 51 Contents 0. 9% Na. Cl $5. 05 Salt $7. 99 Labels Glossy Laser $19. 97 Toner Cartridge $306. 34 Subtotal $326. 31 Crimpers 13 mm $152. 00 20 mm $152. 00 Subtotal $304. 00 Syringes 60 cc Total $112. 51 #IMSH 2014 $2, 316. 32 Units 1440 864 720 Price Per Unit $0. 25 $0. 34 $0. 41 1000 $0. 08 $0. 12 3000 m. L 4 lbs. $0. 002 $0. 02 100 1 $0. 01 1 1 $152. 00 125 $0. 90008 Labor Cost for 500 Vials Sim Tech Non-Tech Hours Per Hour Cost Ordering 3 $20. 00 $60. 00 $14. 00 $42. 00 Production 20 $20. 00 $400. 00 $14. 00 $280. 00 Integration 3 $20. 00 $60. 00 $14. 00 $42. 00 Total $520. 00 Total $364. 00 Labor Cost Per Vial Sim Tech $1. 40 Non-Sim Tech $0. 73 Material Cost Per Vial 2 m. L $0. 45 5 m. L $0. 53 10 m. L $0. 63 20 m. L $0. 73

Cost Per Vial 22 Vial Type Total Material Cost Simulation Tech Labor 2 m. L $0. 45 $1. 40 5 m. L $0. 53 $1. 40 10 m. L $0. 63 $1. 40 20 m. L $0. 73 $1. 40 Non-Sim Tech Labor $0. 73 Vial Type Commercial Cost Tech Produced Vial Non-Tech Produced Vial 2 m. L $1. 32 $1. 85 $1. 18 5 m. L $1. 50 $1. 93 $1. 26 10 m. L $1. 74 $2. 03 $1. 36 20 m. L $2. 75 $2. 13 $1. 46 #IMSH 2014

Cost Analysis 23 Total Yearly Cost Using In-House Simulated Drugs versus Commercial Drugs for Anesthesia Residents Vial Type 2 m. L 5 m. L 10 m. L 20 m. L Total Vials Produced 100 50 75 25 500 Commercial Cost $132. 00 $75. 00 $130. 50 $68. 75 $406. 25 Tech Produced $185. 00 $96. 50 $152. 25 $53. 25 $487. 00 Non-Tech Produced $118. 00 $63. 00 $102. 00 $36. 50 $319. 50 Assumption: A year’s worth of simulated drugs for Anesthesia residents is based upon 3 vials of simulated drugs used during each simulated case, 3 cases per week, 4 times per month, 12 months per year, which equals a total of 432 vials (with an additional 68 vials as a buffer in case more are needed throughout the year) Total Yearly Cost Using In-House Simulated Drugs versus Commercial Drugs for a Class of 60 Nursing Students Vial Type Vials Produced Commercial Cost 10 m. L 720 $1, 252. 80 Sim Produced Non-Tech Produced $1, 461. 60 $979. 20 Assumption: A nursing program with 60 students learning how to draw medications for intravenous administration. Each get three 10 m. L vials of 0. 9% Na. Cl to do this with. Each course occurring 4 times per year. #IMSH 2014 - Making Connections January 2014

References 24 1. 2. 3. 4. 5. 6. 7. Samosky J, Mikulis B, Bregman, R, Nelson, D: A Novel Intravenous Drug Recognition System for Medical Simulators Based on Direct Fluid Identification. Society for Simulation in Healthcare Scientific Abstract Guide 2012; 12: 941 Steadman RH, Coates WC, Huang YM, Matevosian R, Larmon BR, Mc. Cullough L, Ariel D: Simulation-based training is superior to problembased learning for the acquisition of critical assessment and management skills. Critical Care Medicine 2006; 34: 151 -7 Rodgers D, Securro, Jr S, Pauley RD: The Effect of High-Fidelity Simulation on Educational Outcomes in an Advanced Cardiovascular Life Support Course. Simulation in Healthcare 2009, 4: 200 -6 Qayumi K, Donn S, Zheng B, Young L, Dutton J, Adamack M, Bowles R, Cheng A: British Columbia Interprofessional Model for Simulation-Based Education in Health Care. Simulation in Healthcare 2012; 7: 295 -307 Struys MMRF, De Smet T, Mortier EP: Simulated Drug Administration: An Emerging Tool for Teaching Clinical Pharmacology During Anesthesiology Training. Clinical Pharmacology & Therapeutics-Nature 2008; 84: 170 -4 Kimble Chase Life Science and Research Products LLC. Web site. http: //labglass. kimble-chase. com/category/serum-vials&bc=100. Accessed March 18, 2013. #IMSH 2014 - Making Connections January 2014

How to Reach Us 25 Any questions or comments regarding the material presented can be directed to the team at: E-mail: sim@mednet. ucla. edu Visit our website at: www. sim. ucla. edu #IMSH 2014 - Making Connections January 2014

Thank You for Attending 26 Questions? #IMSH 2014 - Making Connections January 2014