Knowledge Award Audio Overview: Propofol wastage audit by Medivet

Hi there, my name’s Rhian Littlehales and I am the Clinical Governance Director at Medivet. I am absolutely delighted to be talking about our propofol wastage audit, which was recognised as a first place champion in the RCVS Knowledge Awards. This project began with such a simple question, how much propofol are we wasting during routine anaesthetic inductions, and is it possible that we could reduce that waste without compromising our patient safety?

And this really came from our colleagues in clinic. As a profession, we’re all starting to become increasingly aware of the importance of sustainability. But our clinicians flag this as an issue, but it’s often difficult to know where to start with something like that.

Propofol is used every day in the vet practice and whilst most of us are really familiar with its benefits, fewer are actually aware of the environmental impact associated with its production. A lot of that is to do with packaging, transport and disposal, and we also recognise that every day clinicians are probably drawing up more propofol than necessary. And that’s not just a sustainability issue, it can influence dosing practices and reduce opportunities to really titrate induction agents accurately to effect.

So we really wanted to understand the scale of the problem. And so our QI committees conducted large scale audits across the four divisions of our company. These involved more than 80 practices and hundreds of team members. And we reviewed over 700 anaesthetic cases and measured the volume of propofol drawn up compared with the volume that we actually administered.

And we were really surprised by what we found, which was about 26% of all propofol being drawn up was being wasted. And when you translate that into actual bottles, it represents a substantial amount of drug, a substantial amount of cost, but also an environmental impact that we probably never really appreciated. So once we’d identified this problem, we looked at all the evidence and thought about how we could work to produce really practical interventions that were simple, that were safe, and that were easy to adopt in our busy clinics.

So these included reducing the initial volume drawn up, encouraging clinicians to titrate to effect rather than preparing the full calculated dose, reviewing pre-med choices where appropriate, and actually also ensuring propofol was only drawn up once we knew a patient or a procedure was actually going to be confirmed and going ahead. And we also reinforced the benefits of that slow IV administration.

We made written guidelines, posters, and had discussions with our colleagues in clinics within meetings so they could understand what we were asking to change and why we were asking them to do this. We had such a great level of engagement with this project. I’m so proud of that. It was not top-down. The topic itself was suggested by our clinicians. We had vets, nurses, patient care assistants, practice managers, divisional leaders, they all contributed to this project, and I’d like to thank them for their contributions.

Our teams were really open in discussing barriers and sharing their experiences as well. And that’s why the project was so successful. So we re-audited over 800 cases and demonstrated a 15.6% reduction in propofol wastage across the organization. We saw increased awareness of sustainability and real consistency in anaesthetic practice.

But I think probably the most surprising finding was how much waste existed within what had become routine. People were drawing up larger volumes just because that’s the way that things had always been done. And behaviour changed really quickly when people had that pointed out to them. If you’re considering a similar project, my advice is don’t underestimate the value of measuring something that feels very routine.

It felt very routine to start with, but presented us with one of the biggest opportunities for improvement. And it was kind of hidden within our clinical habits. And we are so proud that this is now being recognised by the RCVS Knowledge Awards. And I would really like to thank all of our colleagues who were involved in participating in the audit.