The biggest roadblock I face when approaching administrators of surgery centers about prefilled syringes is the price point compared to vials. I get it. My clients don't know what goes on behind the scenes at a 503B compounding facility that leads to the upcharge. It's unlikely they're going to take a day out of their busy schedules to go see how it's all done. But when you compare the cost between two items that serve the same purpose, do you only compare the upfront costs? Of course not. Deciding to make the switch from vials to prefilled syringes is no different.

The price of prefilled syringes is just one variable that should go into your calculation. I tell my clients to first look at all the drugs they buy as single-use vials or ampules and think about what goes into their use. I used to have our pharmacy director look in our trash cans to see what drugs we were throwing out. That's a good place to start to identify drugs that may be better off purchased in prefilled syringes.

• Time. How much time do your nurses spend finding the vial of medication, grabbing the proper needle, drawing it up, labeling it and administering it to the patient? With a prefilled syringe, you just grab the syringe and administer the medication. This could be a huge time-saver, so you need to determine how much your staff's time is worth and include that in your calculation.
• Waste. All vials accessed in the OR are single-use and many centers have adopted a policy to treat all of their vials, even multi-dose, as single-use. So you're always throwing away some medication that didn't make it into the syringe you just drew up. You spent $1 on that 10 mL vial of neostigmine, but you threw out 6 mL of it just now. How much did you waste? You paid for the whole vial and used less than half of it. You then have to factor in the costs of properly disposing of the unused medication. Do you buy disposable containers with chemicals that render the medication unusable or do you buy cartridges for a wall-mounted disposal system? Switching to prefilled syringes could reduce the number of containers or cartridges you need to purchase.
• Materials. There's always the cost of syringes and needles to think about, but if you're drawing up medications from ampules you need to have a filtered needle. These extra materials need to make it into your cost considerations. You also need a dedicated space, away from patient care areas, to draw up the medications. Finding or creating that space takes resources and time that you need to consider.
• Errors. Prefilled syringes can reduce the chance that a medication is drawn up incorrectly or not labeled properly and given to the wrong patient. There are many articles and statistics on medication errors and what they can cost your facility. It's definitely worth calculating how much the reduction in medication errors will save you.
• Shipping costs. Another reason you need to do this calculation drug-by-drug is to look at your usage patterns so you place your orders strategically. When you buy prefilled syringes, the beyond use date (BUD) may be shorter than the vial form. For example, neostigmine has a BUD after 18 months in vial form but prefilled syringes of the drug need to be used in 60-90 days.

I've gotten plenty of calls from surprised facilities saying "I just got my shipment of neostigmine and the BUD is in 20 days. I'm not gonna be able to use them in that time. They're wasted."

A good compounder can tell you the BUD of the drug you're about to order so you can make an informed decision on the amount and when to buy. They can even tell you how much time they think is left in the BUD once it arrives at your facility. If the BUD is in 2 weeks and you don't have many cases scheduled that require neostigmine, maybe don't order a huge shipment. But be aware: Many 503B compounders set a minimum quantity for pre-filled syringe purchases, and it's typically only larger orders that qualify for free shipping.

Easy to cost-justify

Switching to prefilled syringes will never be significantly cheaper than going with vials or ampules. But what you gain can be accounted for in your calculations of cost and will add to the benefits of making the switch. Considerations for improving safety with tamper-proof caps, or increasing compliance with properly labeled syringes, or saving time with ready to go medications are all added values.

Annualizing your costs for each drug, including the considerations above, lets you see whether prefilled syringes will reduce your facility's medication waste or the number of syringes your staff have to fill themselves. If it's only $1,500 more a year to go prefilled, maybe it's a logical way to go for the added safety benefits. After all, the bottom line with prefilled syringes is efficiency, compliance and safety. So you need to do the math to determine how much those benefits are worth to your facility. OSM