Running head: ZERO BASED BUDGET PROPOSAL 1

Zero Based Budget Proposal

Angela Wetli

Bon Secours Memorial College of Nursing

Business of Healthcare in Complex Systems

4240

Mikelaites

September 24, 2016

I pledge

Zero Based Budget Proposal

The objective of this zero based budget proposal is to present the IV form of

Acetaminophen, Ofirmev, to the management of the perioperative department at St Francis

Eastside as an alternative to narcotic pain medicine for surgical patients. Most importantly the

total joint patients and the patients undergoing abdominal surgery. Ofirmev has been shown to

reduce the need for narcotic pain medicine in patients undergoing surgery. The initial cost of the

Ofirmev to the hospital has been an issue in the past, so it has not been widely used. This
proposal will show that the initial cost of the medicine is worth the investment because the

hospital will save money overall due to the patients ease of recovery. The Ofirmev will decrease

the patients need for narcotic pain medication, which will decrease the risk for falls, increase

their mobility and physical therapy, and reduce the length of stay in the hospital. This medication

also does not have some of the other side effects that narcotics do such as respiratory depression,

confusion, and constipation.

Process

The methods used to research this project were discussing the costs and availability of IV

Ofirmev with the staff pharmacist at St Francis Eastside. Costs, side effects, and typical usage of

the medication were also discussed. Internet research was also done using the Average

Wholesale Cost to determine costs of Ofirmev verses the cost of oral Acetaminophen. A journal

article from the American Journal of Managed Care was used to provide statistics on decreased

length of stay and costs for the hospital.

The challenges that were experienced was due to the difficulty of finding the actual costs

of the medication on the internet. Different websites are shown to be available, but the costs are

not easy to find. I was able to find the costs on the hospital electronic medical record due to a

warning sign when the medication is ordered. Also, the management at St Francis Eastside

already have a biased against using the medication due to the initial cost of the medication. It

will be a challenge to present this presentation to an audience that will be accepting to the usage

of the medication.

Presentation
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The target audience for this presentation will be the management of St Francis Eastside

perioperative department, the management of the pharmacy, and the medical director of the

surgical department. The items that were considered during the preparation of this presentation

were the IV form of the medication Acetaminophen, Ofirmev, the oral form of acetaminophen

was considered and the use of only narcotic pain medications without any acetaminophen. The

surgical patients undergoing abdominal surgery and total joint surgeries are the target population

for the use of this medication. Ofirmev has been used at St Francis Eastside in the past, but the

cost of the medication was an issue, so the management decided to try to greatly reduce the

usage of this medication. When the medication was used there was a marked difference in the

recovery unit for the need for narcotics after surgery when the IV Ofirmev was given during

surgery. The facts will be presented regarding the costs of the medications and a request for a

trial within the surgical department to show statistics regarding the use of Ofirmev and the need

for narcotic pain medication following surgery. I will show evidence from the American Journal

of Managed Care regarding length of stay and how the hospital can save money by using

Ofirmev. There was an 18% reduction in LOS, a 28.5% reduction in complication rates, and an

estimated savings of $4.7 million in aggregate (Diaz, 2016).

Reflection

This project was a new experience for me. I have never looked into the finances of the

medications used in my department at work. I want to do the best thing for my patients in order

to decrease their pain after surgery, but the costs of the medications used needs to be accounted

for. The hospital needs to make money in order to continue to operate. I was also under the

impression that it would be easy to find the costs for these medications that I have discussed, but
ZERO BASED BUDGET PROPOSAL 4

I found the opposite to be true. It was very difficult to find the costs and what it would cost the

patient verses what it costs the hospital to provide it.

A new perspective for me regarding the finance and leadership role is that the costs of the

medications given needs to be taken into account as well as the benefit to the patients. The

leadership personnel need to look at the how much the medication costs to give to our patients

and if it profitable or not for the hospital. As a nurse, I typically only look at medications from

the perspective of benefit to the patient, not the cost to the hospital.

In conclusion, this Zero Based Budget proposal will be presented to the management of

St Francis Eastside perioperative services, the management of pharmacy at St Francis Eastside,

and the physician in charge of surgical services at Eastside. The presentation will include the

benefits for the use of IV Ofirmev intraoperatively for our total joint patients and our patients

undergoing abdominal surgery. There will be a request for a trial within the recovery room to

prove the effectiveness of this medication and the decreased need for narcotic pain medications

following surgery.
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References

Diaz, B. (2016). Ofirmev decreases length of stay, costs compared with traditional opiods after

surgery. Retrieved from http://www.ajmc.com/newsroom/ofirmev-decreases-length-of-

stay-costs-compared-with-traditional-opioids-after-surgery