Switching from vials to prefilled syringes may save hospitals thousands of dollars each year by reducing drug waste, according to new findings presented at the 2011 annual meeting of the International Anesthesia Research Society.
Researchers at the Medical University of South Carolina, in Charleston, compared the amount of unused drugs before and after clinicians began using prefilled syringes in a 10-room operating room (OR) suite. They found that the switch cut both the likelihood for and the volume of unused drug drawn into a syringe that would need to be discarded after the procedure. Comparing two time periods covering fewer than 200 surgeries each, the researchers found that this reduction in waste saved $126 per day (abstract S-124).
Prefilled syringes likely reduce waste because they are sealed containers, ready to be used and able to be returned to the shelves if unused, explained study author Christopher Fortier, PharmD, manager of pharmacy support and OR services and clinical assistant professor at the institution.
Often, anesthesiologists will draw up medications into vials in the OR “just in case they may need it,” Dr. Fortier noted. But if that medication is not used, it must be discarded. In contrast, if a prefilled syringe is not used, clinicians can return it, unopened, he said. “In that way, you’re only using the product you need, when you need it.”
The system also cuts waste by reducing the amount of leftover medication in syringes, he added. For instance, an anesthesiologist may prepare 10 mL of a medication but use only 5 mL during surgery; the rest is discarded. But a 5-mL, prefilled syringe would obviate the waste, Dr. Fortier said.
Prefilled syringes are more expensive upfront, Dr. Fortier said. However, the actual cost difference in materials alone is hard to estimate, as clinicians who draw their own must purchase the syringes, labels and needles—and add overhead costs by asking technicians or doctors to draw up medications out of vials prior to surgery.
To investigate whether prefilled syringes cut back specifically on drug costs by curbing waste, Dr. Fortier and his team measured the amount of discarded drugs—either unused or left over in used containers—from 154 surgeries (Phase I). They then compared that amount with what was wasted from 171 surgeries (Phase II) in which doctors used prefilled syringes.
The research was funded by an educational grant from PharMEDium, which sells prefilled syringes.
Fewer cases in Phase II had drug waste (38%) than did Phase I cases, in which 71% had discarded medications. When there were drugs to discard, the total volume decreased by 61%, going from 3,284 mL in Phase I to 1,266 mL in Phase II. As a result, the cost of drug waste fell from $3,106 in Phase I to $1,849 in Phase II, according to the researchers.
The drugs that had the greatest decreases in waste included lidocaine (90%), followed by succinylcholine and glycopyrrolate.
The current study did not look at safety with prefilled syringes, Dr. Fortier noted, but they have some important advantages over conventional syringes. Prefilled syringes are color-coded and have the name of the drug noted in different locations and angles on the syringe. They also contain bar codes that clinicians can scan to ensure they have the right drug.
When clinicians draw up medications from vials, they also must label the syringe, and mistakes can happen, Dr. Fortier said. By using prefilled syringes, “you’re improving safety in how it’s labeled. There’s no question what you’re picking up.”
Indeed, the Anesthesia Patient Safety Foundation has recommended that clinicians rely on prefilled or premixed solutions whenever possible, said Robert Stoelting, MD, president of the group, which has received support from PharMEDium.
The increased upfront cost may cause some clinicians to hesitate before adopting prefilled syringes, Dr. Stoelting said. “This research addresses this issue and thus will be helpful to other institutions when they consider cost versus benefit—considering safety, less risk for contamination and the ability of an anesthesia professional to do other tasks,” he said.
—Alison McCook
