Applying the Delphi technique to define ‘medication wastage’ Lorna Marie West, 1 Lesley Diack, 1 Maria Cordina, 2 Derek Stewart 1 1 Faculty of Health and Social Care, School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, UK 2 Department of Clinical Pharmacology and Therapeutics, Faculty of Medicine and Surgery, University of Malta, Msida, Malta Correspondence to Dr Lorna Marie West, School of Pharmacy and Life Sciences, Faculty of Health and Social Care, Robert Gordon University, Aberdeen AB10 7GJ, UK; l.m.west@rgu.ac.uk Received 19 November 2014 Revised 12 February 2015 Accepted 13 February 2015 Published Online First 19 March 2015 To cite: West LM, Diack L, Cordina M, et al. Eur J Hosp Pharm 2015;22:274–279. ABSTRACT Objective The aim of this study was to apply the consensus-based Delphi technique to define ‘medication wastage’ and its contributory factors. Method The Delphi technique was employed in this study, applying a minimum agreement consensus level of 75%. An expert panel comprising 26 professionals and six patients was recruited and communicated with by email. Round 1 comprised open-ended questions focusing on proposing a definition for ‘medication wastage’ and listing possible contributing factors. In round 2, respondents were requested to rank eight definitions of ‘medication wastage’, derived from round 1, in order of preference. Themes related to contributory factors were presented as 5-point Likert statements. Round 3 included statements that did not meet consensus in round 2. Results Twenty-seven consented to participate, 23 of whom responded to both rounds. Of the eight options for defining ‘medication wastage’, the highest ranked was ‘Medication wastage refers to any medication which expires or remains unused throughout the whole medicines supply chain. Also refers to the unnecessary or inappropriate consumption of medications by patients, or the unjustified non-adherence to treatment guidelines by healthcare professionals. Medication wastage poses a financial burden on patients themselves and the state’s economy and requires adequate education of all people concerned’. Themes related to factors associated with wastage included physical/environmental, social/ psychological (patient/practitioner) and cultural. Conclusions A high level of consensus was achieved on a definition of medication wastage from a diverse panel of academics, practitioners, government officials, officials from non-governmental organisations, and patients in Malta. INTRODUCTION The European Union Waste Framework Directive, 1 issued in 2008, defines ‘waste’ as ‘any substance or object which the holder discards or intends or is required to discard’. This directive focuses on man- agement strategies around issues such as disposal and recycling, but does not include any guidance relating specifically to medication. According to World Health Organization (WHO) global esti- mates published in 2004, more than half of all medication is inappropriately prescribed, dispensed or sold with a resultant ‘wastage of scarce resources and widespread health hazards’. 2 It is likely that the global scale of wastage has increased in the intervening decade due to factors including escalat- ing prescribing volumes and the increasingly elderly population. 3 There are several key consequences of medication wastage for patients, practitioners, healthcare organisations and society. Such wastage imposes an economic burden on all in terms of direct costs related to unused drugs and disposal costs, plus indirect costs, including wasted time spent on activities such as prescribing and dispens- ing. 4 There are further consequences relating to environmental issues associated with wastage dis- posal. Potential contributory factors have been identified as ‘medication changed’, 4–8 ‘patient death’, 4 ‘resolution of patient’s condition’ 7 8 and ‘expired medications’. 78 A recent systematic review of the published lit- erature on medication wastage identified a limited evidence base of interventions to reduce wastage and few studies which included wastage as a primary outcome measure. 9 Only two studies pro- vided any definition or description of wastage: ‘medicines issued to the patient but not con- sumed’ 10 and ‘any drug product, either dispensed by a prescription or purchased over the counter that is never fully consumed. Medication wastage may be due to poor compliance of patients, exces- sive and irrational prescribing, or the lack of control of the sales of prescription medications in the community pharmacy’. 11 This lack of standardised terminology, particu- larly inconsistencies around the definition and scope of wastage, limits direct inter-study compari- sons, potentially impacting the generalisability of findings to other healthcare systems, practices and cultures. Prior to further studying contributory factors, developing strategies to reduce wastage and quantifying impact, it is necessary to adopt a clear definition or description of ‘medication wastage’. Aim of the study The aim of this study was to apply the consensus- based Delphi technique to define ‘medication wastage’ and its contributory factors. Ethics approval The study was approved by the Research Ethics Committees of the School of Pharmacy and Life Sciences, Robert Gordon University, Scotland and the University of Malta. Signed, informed consent was obtained from all participants. METHOD A consensus-based method was employed. Consensus, also termed ‘collective agreement’, involves collaboration, and its approaches are justi- fied in the following situations: where unanimity of opinion does not exist and is sought in view of a lack of scientific evidence or where there is contra- dictory evidence on an issue 12 ; to enhance decision-making 13 ; to develop guidelines, 14 as well 274 West LM, et al. Eur J Hosp Pharm 2015;22:274–279. doi:10.1136/ejhpharm-2014-000593 Original article