Syringes that come prefilled with perioperative medications measured out in their common dosage amounts are designed to simplify drug administration, reduce waste, and prevent infection and medication errors. But purchasing medications in prefilled syringes isn't necessarily the best move for every surgical facility, and you should closely review your own medication practices before deciding to go that route. Here's a look at some of the issues involved.

The prefilled advantage
Many perioperative drugs are available in prefilled syringes, including anticoagulants, some antibiotics, pain relievers (both opioids and non-opioids), heparin flushes and saline flushes. To ease usage and avoid waste, syringes are filled with the most common dosages of each particular drug. For example, morphine is typically available in 2mg, 4mg and 10mg doses. You may also be able to order customized prefilled doses of medications from your pharmacy service. Potential benefits to purchasing medications in prefilled, pre-labeled syringes include:

• Workflow. They're designed to save time and labor by letting staff simply select the correct medication and dosage, open up the package and administer the drugs immediately rather than drawing up medications and labeling syringes manually. Some antibiotics require 15 minutes to 30 minutes to infuse in a minibag, but can be administered using a prefilled push syringe instead, shaving 10 minutes or more off the administering process.
• Infection control. Single-use prefilled syringes reduce the risk of contamination by limiting the amount of manipulation needed to prepare and administer medications. Some also come with built-in safety features to prevent needlestick injuries and the spread of bloodborne pathogens.
• Error prevention. They can also help prevent errors, such as administering the wrong dose or the wrong drug. For example, in 2006 three infants in an Indianapolis hospital died when they were given 10,000 units/ml of concentrated heparin instead of the 10 units/ml heparin flush they were supposed to receive. The products were in vials that looked very similar. Switching a product to a prefilled syringe greatly reduces the chances of confusion. Manufacturers are now taking extra steps, through color-coding and distinctive labeling, to differentiate prefilled syringes by drug type and dosage.
• Compliance. The Joint Commission's National Patient Safety Goals stipulate that any drug that's drawn up in a syringe and not immediately administered must be labeled with the name of the drug, the concentration or amount and the expiration date if it's not going to be administered in the next 24 hours. Prefilled, pre-labeled syringes can help your facility comply with such rules while also saving time and labor.

What are the drawbacks?
The benefits I outlined above may sound great on paper, but adopting prefilled syringes is not without its challenges. The biggest challenge may be cost: Many, but not all, drug products cost more when sold in prefilled syringes than they do when sold in traditional vials. In my experience in the hospital setting, the cost differential varies with each product and in some cases isn't as great as you may expect. You may find that the slightly higher cost per syringe is worth the investment due to the time and labor it saves. Smaller facilities may not be able to defer the increased cost when demand for each product is low. When you're doing your cost-benefit analysis, be sure to get input from frontline staff.

One factor to consider is the relatively limited dosing options you have with prefilled syringes. While they're packaged according to very common doses for each particular drug, they do limit your options for drawing up alternative doses when the need arises. If your physicians and staff adhere very strictly to their dosages and aren't willing to round them to the dose that's available in the product, prefilled syringes may not be worth the investment for you.

A team effort
At my hospital, we conducted a failure modes and effects analysis to determine whether prefilled syringes would improve workflow and reduce the risks posed by nurses drawing up heparin and saline flushes on the floor. Our analysis showed that, compared with existing practices, the prefilled syringes reduced the risk of infection and simplified the process of drawing up, labeling and administering flushes. The nursing staff was particularly satisfied with the results, as they found the prefilled syringes saved a great deal of time and labor. We do roughly 100,000 flushes a year, so we determined that those benefits outweighed the slight increase in cost associated with the prefilled syringes. (For guidance on how to conduct your own FMEA, go to www.ihi.org/ihi/workspace/tools/fmea).

If you've completed the due diligence and determined that prefilled syringes are a good investment for your facility, don't assume that your work is done. To fully realize the benefits of these products, your staff must understand how to use them properly. For example, the Institute for Safe Medication Practices has warned against using prefilled saline flushes to reconstitute antibiotics and then drawing the solution back into the syringe for administration. This process negates the safety benefits of using prefilled syringes in the first place and actually increases the risk of error. Train staff to use prefilled syringes only to administer the drugs and doses for which they're intended. Some prefilled syringes come with safety features or unique activation requirements that are different from the products your staff previously used and require additional training before implementation.