IMSH2014 - Making Connections

Creating Simulated Pharmaceuticals from Laboratory Supplies

January 2014

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How to Supply Your Drug Habit

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#IMSH2014

Meet Our Team

Cory Soto, B.S., CPhT

Simulation Specialist Jamie StinerSimulation Operations Manager

Simulation Specialist

Rukhsana Khan, M.P.H.

Simulation Specialist

Daniel Noji, B.S.Programmer AnalystSimulation Specialist

Jeffrey Rusheen, M.D.Assistant Professor

Anesthesiology

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Disclosure(s) We have nothing to disclose.

Commercial vendors mentioned in this presentation are merely used as examples. We do not receive any compensation from them.

January 2014

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Learning Objectives 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.

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Does your Simulation Center…

January 2014

Use expired drugs?

Buy commercially available simulated drugs?

Make your own?

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The Problems

January 2014

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A Solution: Do It Yourself!

January 2014

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Get The Right Tools for the Job

January 2014

Outside Diameter, or O.D.

Borosilicate Vial 0.9% NaCl (Normal Saline)

Syringe

Table Salt

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Get The Right Tools for the Job

January 2014

Flip-Off Cap

Stopper

Flip-Off Cap Crimper

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Step One: Filling and Sealing

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Step Two: Capping

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Wow, That Was Easy!

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Step Three: Crimping

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The Assembled Vial

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Now You Get To Do It!

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Step Four: Labeling

January 2014

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Meet SOPHIE

January 2014

Simulated Online Pharmaceutical Image Editor

No need for expensive image editing suites

Developed by the UCLA Simulation Center for use by other Simulation Centers at no cost

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What Does Your Center Need to Maintain Their Drug Habit?

January 2014

Common/Crash Cart Meds

Medications for Rare Conditions (Dantrolene for Malignant Hyperthermia, Blood Factors, etc.)

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Needs Assessment

January 2014

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.

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Simulated Drugs Currently Available at UCLA

January 2014

Adenosine Famotidine MidazolamAmiodarone Flumazenil Naloxone

Atropine Furosemide NeostigmineCalcium chloride Glucagon NitroglycrinDexamethasone Glycopyrrolate Norepinephrine

Digoxin immune fab Heparin PhenylephrineDiltiazem Hydralazine Propofol

Diphenhydramine Insulin RocuroniumDopamine Labetalol SuccinylcholineEsmolol Magnesium sulfate Vasopressin

Etomidate Metoclopramine Verapamil

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The Cost of Production

Vials Cost Units Price Per Unit2 mL $362.78 1440 $0.255 mL $213.80 864 $0.25

10 mL $292.20 864 $0.3420 mL $297.89 720 $0.41

Subtotal $1,166.67Stoppers

13 mm $77.62 1000 $0.0820 mm $120.65 1000 $0.12

Subtotal $198.27Flip-Off Caps

13 mm $82.24 1000 $0.0820 mm $121.27 1000 $0.12

Subtotal $203.51Contents0.9% NaCl $5.05 3000 mL $0.002

Salt $7.99 4 lbs. $0.02Labels

Glossy Laser $19.97 100 $0.01Toner Cartridge $306.34 1 $0.01

Subtotal $326.31Crimpers

13 mm $152.00 1 $152.0020 mm $152.00 1 $152.00

Subtotal $304.00Syringes

60 cc $112.51 125 $0.90008

Total $2,316.32

HoursSim Tech Per Hour

Sim Tech Cost

Non-Tech Per Hour

Non-Tech 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

Material Cost Labor Cost for 500 Vials

Labor Cost Per VialSim Tech Non-Sim Tech

$1.40 $0.73

Material Cost Per Vial2 mL 5 mL 10 mL 20 mL$0.45 $0.53 $0.63 $0.73

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Cost Per Vial

Vial Type Commercial Cost Tech Produced Vial Non-Tech Produced Vial2 mL $1.32 $1.85 $1.185 mL $1.50 $1.93 $1.26

10 mL $1.74 $2.03 $1.3620 mL $2.75 $2.13 $1.46

Vial Type Total Material Cost Simulation Tech Labor Non-Sim Tech Labor2 mL $0.45 $1.40 $0.735 mL $0.53 $1.40 $0.7310 mL $0.63 $1.40 $0.7320 mL $0.73 $1.40 $0.73

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Cost Analysis

January 2014

Total Yearly Cost Using In-House Simulated Drugs versus Commercial Drugs for Anesthesia Residents

Total Yearly Cost Using In-House Simulated Drugs versus Commercial Drugs for a Class of 60 Nursing Students

Vial Type Vials Produced Commercial Cost Sim Produced Non-Tech Produced10 mL 720 $1,252.80 $1,461.60 $979.20

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)

Assumption: A nursing program with 60 students learning how to draw medications for intravenous administration. Each get three 10 mL vials of 0.9% NaCl to do this with. Each course occurring 4 times per year.

Vial Type Vials Produced Commercial Cost Tech Produced Non-Tech Produced2 mL 100 $132.00 $185.00 $118.00 5 mL 50 $75.00 $96.50 $63.00

10 mL 75 $130.50 $152.25 $102.00 20 mL 25 $68.75 $53.25 $36.50 Total 500 $406.25 $487.00 $319.50

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References

January 2014

1. 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

2. Steadman RH, Coates WC, Huang YM, Matevosian R, Larmon BR, McCullough L, Ariel D: Simulation-based training is superior to problem-based learning for the acquisition of critical assessment and management skills. Critical Care Medicine 2006; 34:151-7

3. 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

4. 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

5. 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

6. Kimble Chase Life Science and Research Products LLC. Web site. 7. http://labglass.kimble-chase.com/category/serum-vials&bc=100. Accessed March

18, 2013.

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How to Reach Us

January 2014

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

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Thank You for Attending

January 2014

Questions?