Review of drug usage following implementation of emergency grab boxes across Cardiff and Vale Trust

Authors: S. Wallis, L. Coutis, N. Goodwin


The NHS is in a period of economical fragility. This, combined with increasing awareness of environmentally friendly healthcare, has driven a change to sustainable service provision. One such area is pharmaceutical rationalisation [1, 2]. Theatre suites must be equipped with rapid access to a variety of drugs to enable timely access; however, this provision of stock often leads to wastage of expired drugs and duplication of stock. We have demonstrated a Trust-wide change in practice, which we postulate has reduced drug ordering and reduced wastage.


After the project was trialled in the children’s theatre suite, emergency grab boxes

were made for six common emergencies (anaphylaxis, bronchospasm, seizure, hyperkalaemia, arrhythmia and hypotension) using toolboxes (Fig. 1). They were stocked

with the appropriate drugs and equipment required to deliver them, along with the

appropriate emergency guidelines. These were placed at strategic points across the

theatre complexes to ensure ready access. Drugs that would not be expected to be

routinely used over a 2-week period were then removed from each specialty specific

theatre. We compared pre- and post-implementation drug ordering to review if there

was a reduction and undertook an adjusted cost-minimisation analysis

Figure 1 Grab-box station.


Qualitative feedback has been positive with no reports of delay in access to drugs. Quantitative review of drug ordering over a 3-month period both pre- and post-implementation in our main theatre suite was undertaken (three separate grab-box

stations). This demonstrated a reduction in order quantity in 74% of included drugs

(n = 25). With an adjustment made for individual drug cost variation between the

time periods, the total cost saving for the theatre suite boxes was £1,761. The maximal saving was on the anaphylaxis box with the greatest reduction in spending on epinephrine (£1,207). Data analysis across other sites is on-going.


Although causality cannot be assumed, there has been a significant reduction in the

majority of emergency drugs reviewed. This is reflected in a significant saving for the

department estimated to be in excess of £5000 across all sites. There have been no other significant changes in practice during the study period. This intervention has successfully improved theatre drug-storage efficiency, reduced waste whilst improving accessibility to emergency drugs.


The authors thank the University Hospitals Wales Pharmacy Department.


1. Majeed A, Firdous A, AlBabtain H, Iqbal T. Cost drain of anesthesia emergency

drugs in a quaternary care hospital. Saudi Journal of Anaesthesia 2019; 13: 203–7.

2. Rowe WL. Economics and anaesthesia. Anaesthesia 1998; 53: 782–8.