Implementation of dispense waste functionality with new electronic health record system.

Clinical Snapshot

Key Findings

• P Value: P < 0.001

• Effect Size: Increase from 31.1% to 85.9% (54.8 percentage point improvement)

• Primary Outcome: Real-time waste documentation compliance during drug preparation

• Nnt Or Sensitivity: Absolute risk reduction of 54.8% suggests approximately 2 staff members need training for 1 to achieve compliant documentation

• Confidence Interval: Not reported

Clinical Application

Requires electronic health record system capability, dedicated pharmacy technician time for retrospective review, and ongoing staff education programs Relevant for Australian hospitals implementing PBS compliance measures and medication waste reduction initiatives, though specific JZ modifier requirements are US-specific. Principles applicable to TGA reporting requirements and hospital accreditation standards Hospital pharmacy departments implementing electronic health record systems for medication waste tracking, particularly pediatric hospitals with high single-dose container usage

Abstract

PURPOSE: Practice changes were implemented and adjusted to ensure regulatory compliance with JZ modifier documentation. SUMMARY: The JW modifier allows institutions to bill for partially unused and discarded single-dose containers of drugs and biologics, whereas the JZ modifier is used to report that no amount of drug was discarded from a single-dose container. These modifiers are essential for accurate coding and resource stewardship, especially in pediatric hospitals, where medication doses are often patient specific and require manipulation of single-dose containers. Starting July 1, 2023, the Centers for Medicare & Medicaid Services required providers to report the JZ modifier on all claims that bill for drugs from single-dose containers. Our institution underwent a soft go-live in June 2023, which allowed the institution to make necessary process changes to ensure regulatory compliance. In June 2023, only 31.1% of waste was documented at the time of medication preparation. To capture waste documentation post preparation, a pharmacy technician was trained to review missed opportunities and document waste retrospectively. Monthly monitoring of waste documentation, including missed opportunities during drug preparation, was conducted and further staff education was provided. A reassessment of waste documentation was completed in February 2024, which highlighted that real-time waste documentation completed during compounding had increased to 85.9%. By documenting waste during drug preparation, the resources spent reviewing reports for drug preparations from the previous day and the need to document waste are reduced. CONCLUSION: Through process implementation and staff education, compliance with real-time waste documentation during drug preparation increased from 31.1% to 85.9% (P < 0.001) in 8 months.

References

1. 1.Baumann, A., Fitzpatrick, N., Fitzgerald, D., & Brasher, C. (2026). Implementation of dispense waste functionality with new electronic health record system. American Journal of Health-System Pharmacy, 83(8), 234-241. https://doi.org/10.1093/ajhp/zxaf334