Prefilled Syringes Are the Preeminent Option

The benefits of these precise and efficient medications make ditching traditional vials an easy choice for surgical leaders.

Superior safety benefits and error-reduction capabilities. Significant time savings. Reduced waste. The benefits of premixed, prelabeled syringes far outweigh the minimal drawbacks, so why are there still facilities that insist on resisting prefilled syringe adoption? 

“While we know that prefilled syringes are safer, I think the hesitation comes from a misunderstanding that it’s not cost effective, that somehow having the user prepare the dose using a vial and syringe is less expensive,” says Susan Paparella, MSN, RN, vice president of the Institute for Safe Medication Practices (ISMP), a non-profit organization dedicated to medication safety education located in Plymouth Meeting, Pa. At least part of this hesitancy comes from a lack of data showing the opposite may in fact be true. But thanks to new research on the cost effectiveness of prefilled medications, the price-tag myth is effectively being challenged. For instance, a recent study in Pain and Therapy found that the use of manufacturer-prepared prefilled ready-to-administer (RTA) syringes can reduce healthcare costs by decreasing errors compared with the traditional vial-and-syringe method. Specifically, the study found that manufacturer-prepared prefilled RTA syringes were associated with an estimated savings of $182.61 per administration and a 94% reduction in errors compared with the traditional IV push vial-and-syringe method. Of course, that’s just one study in an area that has been notoriously unresearched. However, there are a host of benefits to prefilled syringes that have been well documented:

• Safety. Perhaps none of the multiple safety benefits inherent in prefilled syringes are more important than the technology that’s worked right into the label of the syringes themselves. “In my opinion, one of the most important benefit is that prefilled syringes have barcodes on their label, which can can enable electronic medication checks and clinical decision algorithms in the OR,” says Karen C. Nanji, MD, MPH, assistant professor at Harvard Medical School in Boston. The labels, she says, then enable medication safety software to provide critical information like patient-specific dosing, drug interactions, calculators or alerts for things like allergies — the types of safety checks that can be extremely difficult to incorporate at the time of medication administration when the syringes are prepared by providers. That’s because clinician-prepared labels often don’t have barcodes. The importance of this protection cannot be overstated. “Prefilled syringes themselves help reduce labeling and medication-preparation errors, but then adding the barcode and medication safety software prevents all the other types of mistakes like wrong medication, wrong dose, wrong time, and opens up the doors for a really robust, comprehensive solution to medication errors,” says Dr. Nanji. Ms. Paparella echoes Dr. Nanji’s enthusiasm for the benefits barcode-scanning capabilities. “Using barcode scanning as a safety redundancy helps the nurse or an anesthesia provider scan the medication and confirm their selection before administration, making for a much safer and more efficient process,” she says.

Prefilled syringes also don’t require clinicians to prepare and dilute the medication, something that increases the chances of human error in the OR. Plus, they offer greater sterility, a key and often-understated safety benefit. “By reducing the handling of the medications by clinicians, you’re also increasing the level of sterility,” says Dr. Nanji, adding that this is especially true in cases where the medications are manually prepared by the clinicians and kept for use later in the day. “Sometimes this delay leaves hours for bacteria to grow in that medication throughout the day,” she says. 

The most important benefit is that prefilled syringes have barcodes on their label, which can be scanned when 
they’re administered to patients.
Karen C. Nanji, MD, MPH

While prefilled syringes are generally safer than the more onerous provider-prepared vial-and-syringe method, facilities leaders must be diligent when purchasing their medications from the vendors. Ms. Paparella says that without careful oversight, there are safety risk when outsourcing custom prefilled syringes from compounding partners. “ISMP has received numerous hazard complaints and error reports because of the lack of standardization of the labeling of prefilled syringes,” she says. For instance, Ms. Paparella says, some compounders will deviate from USP general chapter <7> labeling standards and create labels that list the strength per milliliter as the primary expression on the label, rather than listing the strength for the total volume of the syringe, a deviation that can confuse providers who are accustomed to seeing one standard, traditional expression of strength. Ms. Paparella provides two critical pieces of safety advice for facility leaders when choosing a prefilled vendor: “Acquire prefilled syringes that follow USP general chapter <7> labeling practices and employ barcode scanning of the final product as much as possible,” she says. There are also plenty of easily accessible resources such as the American Society of Health-System Pharmacists’ vendor assessment tool. 

• Time savings. Not only are premixed, prelabeled medications safer than their dilute, draw and dose counterparts, they are also more efficient, and time is a commodity short-staffed, high-volume facilities simply can’t get enough of right now. “With prefilled syringes, the clinician doesn’t need to prepare and dilute the medication from the vial before placing it into a syringe, and that saves time and reduces clinician burnout, something that is more important than ever after the pandemic we just went through,” says Dr. Nanji. The time-saving element is particularly apparent when purchasing prefilled ophthalmic meds from a compounder. These tend to be medications that cannot be reliably duplicated without a significant amount of preparation and effort.

• Waste reduction. Speaking of efficiency, prefilled syringes eliminate one of the most frustrating components of provider preparation: The medication waste that’s required when drawing up your own drugs. Prefilled syringes contain the exact amount of medication required to administer to patients, something that can’t be said for the clinician-administered option. “If the most common amount needed is three milliliters of a specific medication, the prefilled syringe will be filled with exactly three milliliters, while the vial might be filled with five or 10 mls,” says Dr. Nanji. “This results in most of the medication in that vial being discarded.” In fact, Dr. Nanji adds, vials require overfilling by up to 25%, because manufacturers need to account for clinicians not being able to draw every last drop into a syringe. “Even when vials try to contain the most common amount needed, there’s overfilling,” she says. “This waste does not exist with prefilled syringes.” The waste-reducing properties of prefilled syringes should be used to offset their higher upfront, says Dr. Nanji. “While prefilled syringes can cost more per milliliter than a vial, there’s less medication waste with prefilled syringes, so you can actually save money in the long run on the cost of wasted medication,” she says. 

Proven results

Dr. Nanji’s research focuses on medication safety in the OR, an area in which she and her team develop and test effective strategies to prevent those errors. Her work has provided her with a firsthand look at how and why these medication errors are happening in the first place. 

For instance, her team published a study in which observers in the OR monitored medication administration and outlined the different types of errors that occurred during the process. “Labeling errors were one of the most common error types that occurred, representing almost a quarter of the medication errors in our study,” she says. “Prefilled syringes are a great solution that can reduce the incidence of labeling errors.” 

That error-reduction potential alone should be more than enough to trigger a switch to prefilled syringes for providers, but as we’ve just discussed, there are plenty of other benefits of this option, as well. OSM