Background: Sodium bicarbonate infusions are primarily used for severe metabolic acidosis and select toxicologic emergencies. Variability in the prescribed concentration and diluents can contribute to medication errors, workflow inefficiencies, and unnecessary waste. On August 19, 2025, Piedmont Healthcare implemented a standardized sodium bicarbonate infusion order set for non-nephrology providers, reducing seven options to two options (150 mEq sodium bicarbonate in one liter of either sterile water for injection or 5% dextrose in water). This study evaluated the financial and operational impact of this standardization intervention.
Methods: This single-center, retrospective, pre-post study evaluated orders from a sodium bicarbonate infusion order set at Piedmont Columbus Regional Midtown during a pre-standardization period (May – June 2025) and a post-standardization period (November – December 2025) following implementation of a simplified order set. All objectives were evaluated using data from 50 randomly selected patient charts per period. Patient charts were excluded if the ordering provider was a nephrologist or if the order was never prepared. The primary objective, total cost of waste, was defined as the difference between the cost of the product made and the cost of the product administered using average wholesale prices. Secondary outcomes included pharmacy labor inputs and time to first dose. Descriptive statistics were used to evaluate all outcomes.
Results: Baseline characteristics were similar between groups, with metabolic acidosis as the most common indication for continuous infusion of sodium bicarbonate. In the pre-standardization group, the most frequently ordered products were 150 mEq of sodium bicarbonate in sterile water or 5% dextrose in water, which informed the retention of these options in the standardized order set. The proportion of wasted infusions among the 50 randomly selected patients per group improved from 23% wasted pre-standardization to 14% wasted post-standardization, an absolute waste reduction of 9%. Using average wholesale price to estimate the primary outcome of cost of waste, extrapolation to the number of infusions dispensed in 2025 demonstrated a reduction in estimated annual waste from $28,315 pre-standardization to $17,220 post-standardization, yielding an annual cost savings exceeding $11,000. For secondary outcomes, pharmacy labor time was similar between groups, while time to first dose improved by approximately 7 minutes in the post-standardization group.
Conclusions: This study found that implementation of a standardized sodium bicarbonate infusion order set for non-nephrology providers reduced waste and saved cost. There was not a meaningful difference in time spent on pharmacy labor, but there was a slight improvement in time to first dose after standardization. Future directions include implementation of batch preparation of the standardized doses to significantly reduce the amount of pharmacy labor needed per bag, and to further reduce time to first dose.
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