Drug Wastage : Observational Study in Intensive Care Units in France (GAME-OVER)

Environmental awareness leads medical field to question its responsibility and possibilities for action.

Drug residues can have a major environmental impact as per their bioaccumulation, toxicity and persistence characteristics, depending on where they are discarded. In France, drug residues should be disposed of by incineration, but in practice, this is not systematic. Moreover, data on drug wastage in Intensive Care Units (ICU) are rare.

GAME-OVER observational study aims to evaluate drug wastage in ICU in France and to suggest ways to improve health care practices.

Study Overview

• Status: Completed
• Conditions: Drug Use
• Intervention / Treatment: Other: Quantification of IV drugs wastage

Detailed Description

Observational study with data collection during a 24-hour business day. Data collected refer to healthcare team's practices and patients.

Collection starts when day shift starts (at 7:00 am) and ends when night shift leaves (at 7:00 am the following day).

• Study Type: Observational
• Enrollment (Actual): 1066

Contacts and Locations

Study Locations

• France
  • Limoges, France, 87042
    • CHU Dupuytren
  • Paris, France, 75010
    • Hopital Lariboisiere
  • Paris, France, 75013
    • Hôpital La Pitié-Salpétrière
  • Paris, France, 75018
    • Hôpital Bichat
  • Ardennes
    • Charleville-Mézières, Ardennes, France, 08000
      • Centre Hospitalier de Charleville-Mezieres
  • Bas-Rhin
    • Strasbourg, Bas-Rhin, France, 67098
      • CHRU de Strasbourg
  • Bouches Du Rhône
    • Marseille, Bouches Du Rhône, France, 13015
      • Hopital Nord
  • Cantal
    • Aurillac, Cantal, France, 15000
      • Centre Hospitalier d'Aurillac
  • Charente-Maritime
    • La Rochelle, Charente-Maritime, France, 17019
      • Groupe Hospitalier Littoral Atlantique
  • Doubs
    • Besançon, Doubs, France, 25000
      • CHU de Besancon
  • Drôme
    • Montélimar, Drôme, France, 26216
      • Centre Hospitalier de Montelimar
  • Essonne
    • Quincy-sous-Sénart, Essonne, France, 91480
      • Hôpital Privé Claude Galien
  • Finistère
    • Brest, Finistère, France, 29240
      • HIA Clermont Tonnerre
    • Brest, Finistère, France, 29609
      • CHRU de Brest
  • Gard
    • Nîmes, Gard, France, 30900
      • CHU de Nîmes
  • Gironde
    • Bordeaux, Gironde, France, 33000
      • Clinique Saint Augustin
    • Bordeaux, Gironde, France, 33076
      • CHU de Bordeaux - Hôpital Pellegrin
    • Bordeaux, Gironde, France, 33140
      • HIA Robert Picqué
    • Libourne, Gironde, France, 33500
      • Hôpital Robert Boulin
  • Haute Garonne
    • Toulouse, Haute Garonne, France, 31059
      • CHU de Toulouse - Hôpital Purpan
  • Haute-Garonne
    • Quint-Fonsegrives, Haute-Garonne, France, 31130
      • Clinique La Croix Du Sud
    • Toulouse, Haute-Garonne, France, 31059
      • CHU de Toulouse - Hôpital Rangueil
    • Toulouse, Haute-Garonne, France, 31300
      • Clinique Pasteur
  • Haute-Loire
    • Le Puy-en-Velay, Haute-Loire, France, 43000
      • Centre Hospitalier Emile Roux
  • Hauts-de-Seine
    • Antony, Hauts-de-Seine, France, 92160
      • Hopital Prive d'Antony
    • Clamart, Hauts-de-Seine, France, 92141
      • HIA Percy-Clamart
    • Neuilly-sur-Seine, Hauts-de-Seine, France, 92200
      • Hôpital Américain de Paris
  • Ille-et-Vilaine
    • Rennes, Ille-et-Vilaine, France, 35033
      • CHU de Rennes
  • Indre-et-Loire
    • Chambray-lès-Tours, Indre-et-Loire, France, 37170
      • CHRU De Tours
  • Isère
    • La Tronche, Isère, France, 38700
      • CHU de Grenoble
  • Landes
    • Dax, Landes, France, 40100
      • Centre Hospitalier de Dax
    • Mont-de-Marsan, Landes, France, 40024
      • Centre Hospitalier de Mont-de-Marsan
  • Loir-et-Cher
    • Blois, Loir-et-Cher, France, 41000
      • Centre Hospitalier Simone Veil
  • Loire-Atlantique
    • Saint-Nazaire, Loire-Atlantique, France, 44600
      • Centre Hospitalier de Saint Nazaire
  • Loiret
    • Orléans, Loiret, France, 45100
      • Centre Hospitalier d'Orléans
  • Lot
    • Cahors, Lot, France, 46005
      • Centre Hospitalier de Cahors
  • Maine-et-Loire
    • Angers, Maine-et-Loire, France, 49100
      • CHU d'Angers
  • Manche
    • Saint-Lô, Manche, France, 50000
      • Centre Hospitalier Mémorial de Saint-Lô
  • Marne
    • Reims, Marne, France, 51100
      • CHU de Reims
  • Morbihan
    • Vannes, Morbihan, France, 56017
      • Centre Hospitalier Bretagne Atlantique de Vannes
  • Nord
    • Lille, Nord, France, 59037
      • CHU de Lille - Hôpital Huriez
    • Lille, Nord, France, 59037
      • CHU de Lille - Hôpital Roger Salengro
  • Pays de la Loire Region
    • Montbrison, Pays de la Loire Region, France, 42600
      • Centre Hospitalier du Forez
    • Saint-Priest-en-Jarez, Pays de la Loire Region, France, 42270
      • CHU de Saint-Etienne
  • Puy-de-Dôme
    • Clermont-Ferrand, Puy-de-Dôme, France, 63003
      • CHU de Clermont-Ferrand
  • Rhône
    • Bron, Rhône, France, 69677
      • Hopital Pierre Wertheimer
    • Lyon, Rhône, France, 69003
      • Hôpital Edouard Herriot
    • Lyon, Rhône, France, 69009
      • Clinique de la Sauvegarde
  • Réunion
    • Saint-Denis, Réunion, France, 97400
      • CHU Félix-Guyon
    • Saint-Pierre, Réunion, France, 97410
      • CHU de la réunion
  • Seine-et-Marne
    • Meaux, Seine-et-Marne, France, 77100
      • Grand Hôpital de l'Est Francilien
  • Somme
    • Amiens, Somme, France, 80054
      • CHU d'AMIENS
  • Territoire De Belfort
    • Trévenans, Territoire De Belfort, France, 90400
      • Hôpital Nord Franche-Comté
  • Val d'Oise
    • Argenteuil, Val d'Oise, France, 95100
      • Centre Hospitalier Victor Dupouy
  • Val-de-Marne
    • Créteil, Val-de-Marne, France, 94000
      • Hôpital Henri Mondor
  • Var
    • Toulon, Var, France, 83056
      • Hopital Sainte Musse
    • Toulon, Var, France, 83000
      • HIA Sainte Anne
  • Vienne
    • Poitiers, Vienne, France, 86021
      • CHU De Poitiers
  • Yvelines
    • Le Chesnay, Yvelines, France, 78150
      • Centre Hospitalier de Versailles
• Mayotte
  • Mamoudzou, Mayotte, 97600
    • Centre hospitalier de Mayotte
• Monaco
  • Monaco, Monaco, 98000
    • Centre Hospitalier Princesse Grace

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Adult patients hospitalized in intensive care units during the 24 hours of data collection.

Description

Inclusion Criteria:

• Adult patients hospitalized in intensive care units during the 24 hours of data collection.

Exclusion Criteria:

• Patient's opposition to participate in the study or patient family opposition if the patient is not able to be informed.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Intravenous (IV) drugs; Patient and prepared/administrated/discarded IV drugs data will be collected during 24 hours.	Other: Quantification of IV drugs wastage; Drugs are prescribed depending on physician discretion. Specific collection bins are provided to ICU. Healthcare teams discard syringes labelled with name and dilution which have been used to prepare drugs into these bins. After 24 hours of collection, bins are analyzed by investigators.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Ratio of overall wastage in milliliter (mL) of prepared and discarded IV drugs to overall volume in milliliter (mL) of prepared IV drugs.	Wastage is defined as any prepared and unused drug that remains in syringe or IV bag.	24 hours

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Reason for discarding drug residues	A questionnaire will be fulfilled by healthcare teams with the following possible categories: 1/ prepared in advance and not used ; 2/ systematic change at fixed times ; 3/ prescription change ; 4/ change by anticipation of care ; 5/ drug no longer needed ; 6/ preparation error ; 7/ other reason.	24 hours
Drug residues discarding process	A questionnaire will be used to determine which discarding process are applied by nurses in their usual pratices.	24 hours
Use of enteral administration route	Use of enteral administration route versus per os and IV routes will be analyzed for paracetamol and proton pump inhibitor according to the accessibility of enteral route and the reason and the date of patient entry in ICU.	24 hours
Cost of overall IV drug wastage	Estimated cost of drug residues will be evaluated for each drug, according to the reason for discarding, by the following formula : volume of discarded IV drugs x theoretical price	24 hours

Collaborators and Investigators

• Sponsor: Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
• Collaborators: Sainte-Anne Military Teaching Hospital
• Investigators: Study Director: Erwan D'ARANDA, MD, Sainte-Anne Military Teaching Hospital

Publications and helpful links

General Publications

• d'Aranda E, Cungi PJ, Chelly J, Pons S; GAME-OVER Study Group, GAME-OVER Study Investigators, French Society of Anesthesia & Intensive Care Medicine (SFAR) Sustainability; Committee, SFAR Critical Care Committee, and SFAR Research Network; GAME-OVER Study Group, GAME-OVER Study Investigators, French Society of Anesthesia & Intensive Care Medicine (SFAR) Sustainability and Committee, SFAR Critical Care Committee, and SFAR Research Network. Sustainable Intensive Care: Do Not Forget IV to Oral Switch! Crit Care Med. 2026 Jan 1;54(1):218-223. doi: 10.1097/CCM.0000000000006944. Epub 2026 Jan 6. No abstract available.
• d'Aranda E; GAME-OVER investigators group; Pons S, Chelly J, Atchade E, Bonnet L; SFAR Sustainable Development Committee; Dahyot-Fizelier C; SFAR Critical Care Committee; Kamel T, Giannoni F, Collange O, Besnier E, Schoeffler M, Mayeur N, Quere PL, Marecal L, Pernod C, Geay C, Esnault P, Cinotti R; SFAR Research Network; Cesana M, Cungi PJ. Discarded intravenous medication in the ICU: the GAME-OVER multicenter prospective observational study. Crit Care. 2025 Feb 21;29(1):84. doi: 10.1186/s13054-025-05299-6.
• Atchade E, Cungi PJ, Pons S, Dahyot-Fizelier C, Cesana M, Lukaszewicz AC, Bouhemad B, Trouiller P, Chelly J, Montravers P, Vardon F, D'Aranda E; SFAR Critical Care Committee; SFAR Sustainability Committee; SFAR Research Network; GAME-OVER Study group; GAME-OVER investigators group. Characteristics of French intensive care units and patients: an ancillary analysis of the GAME-OVER study. BMC Anesthesiol. 2025 Dec 5;26(1):27. doi: 10.1186/s12871-025-03473-5.

Study record dates

Study Major Dates

• Study Start (Actual): November 8, 2022
• Primary Completion (Actual): March 15, 2023
• Study Completion (Actual): March 15, 2023

Study Registration Dates

• First Submitted: September 21, 2022
• First Submitted That Met QC Criteria: September 21, 2022
• First Posted (Actual): September 23, 2022

Study Record Updates

• Last Update Posted (Actual): April 13, 2026
• Last Update Submitted That Met QC Criteria: April 10, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Intensive Care Unit (ICU); Intravenous (IV) drug; Waste; Environmental sustainability; Drug wastage; Care Eco-design
• Other Study ID Numbers: 2022-CHITS-009

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No