Most Popular Prefilled Syringes

When does it make the most sense to buy prefilled syringes? Some say if you administer a drug 10 times or more a day, you’ll save considerable time not having to draw it up, label it and put it on the field. Others say if you’re always throwing away some medication that didn’t make it into the syringe you just drew up, you’ll actually spend less per cc if you go prefilled. Then there are those who say you should go prefilled if the compounding pharmacy’s beyond-use date (BUD) for a refrigerated item is significantly longer than the manufacturer’s expiration date. Whatever the reason, this much is certain: Prefilled syringes can play a key role in surgery.

About 9 months ago, the head of anesthesia at Lakeside Ambulatory Surgery Center in Omaha, Neb., asked pharmacy coordinator Louise Bergeron, RN, BSN, MS, if they could look into using prefilled syringes for certain medications. Since then, Lakeside has been using prefilled neostigmine, ephedrine, glycopyrrolate, succinylcholine and phenylephrine daily. And they’re very happy about the decision.

“The anesthesiologist told me his group used prefilled syringes at other facilities, and they were a far safer option,” says Ms. Bergeron. The safety aspect alone was enough for her to start looking into adding the ready-made drugs to her inventory, but she soon discovered other benefits.

“For something like ephedrine, I didn’t realize anesthesia had to dilute the medication from the ampoules before drawing them up for use,” says Ms. Bergeron. “So there was a major time-savings and convenience component to using prefilled drugs, too.”

But that wasn’t all. “I saw a noticeable lift in the morale of anesthesia,” she says.

Ms. Bergeron is part of a growing group of surgical facility leaders who use prefilled syringes on a daily basis. One-fourth (25.71%) of the 105 leaders in hospitals and ambulatory surgery centers we surveyed use prefilled syringes “daily.” More than one-half (51.43%) “never” use these medications, 4.76% use them “a few times per week” and 5.71% use them “once per month or so.” Another 12.38% rarely go the prefilled route.

Top prefilled medications

The most common prefilled syringe is phenylephrine, followed by lidocaine, ephedrine, propofol and succinylcholine. Sheldon S. Sones, RPh, FASCP, a pharmacy consultant and safe medication management officer at more than 130 ambulatory facilities, says there are 4 compelling reasons these meds are purchased from compounding pharmacies:

• Ease of administration. Prefilled medications are easy for anesthesia to administer. Plus, these drugs minimize questions about sterile technique. When your staff is drawing up the syringes themselves, it’s a process that’s rife with potential problems. With prefilled syringes, you simply take off the cap and inject it, says Mr. Sones.
• Specific dosing needs. This is especially true in the case of intracameral ophthalmic drugs like moxifloxacin and cefuroxime where the dosing needs are very specific.
• Drug shortages. The top 5 medications from our survey have all been in short supply at one time or another.
• Expanded shelf life. In the case of prefilled succinylcholine, you can store the drug at room temperature for significantly longer than multi-dose vials: 90 days versus 14 days.

Respondents weighed in on other drugs they’re considering getting from a compounder. One was considering prefilled for “all meds that are multi-dose vials.”

Gina Schilthuis, RN, a clinical director at Baylor Scott & White Surgicare in Dallas, Texas, who already gets rocuronium, neostigmine and succinylcholine in prefilled syringes, might add Wydase (hyaluronidase).

Carrie Robertson, RN, BSN, nurse manager at Albuquerque (N.M.) Ambulatory Eye Surgery Center, might order vancomycin in a prefilled syringe. “We want to get away from us mixing it ourselves,” she says. “Also, our consultant pharmacist insists that we use one vial per patient — which is not going to happen. We are trying to find a way to satisfy the one-dose-per-patient rule.”

Safety, cost and supply shortages

Our survey found facilities go with a compounding pharmacy primarily for safety, cost savings or because of a supply shortage. More than half (56.86%) of respondents said safety was a “critically important” reason for using a compounder. As Lakeside’s Ms. Bergeron puts it: “The cost is not that much more, and patient safety is more important than cost.” Ms. Bergeron isn’t alone with this sentiment. Most respondents viewed prefilled syringes as superior from a safety perspective — 59.70% either “strongly agree” or “agree” with the statement: “Buying prefilled syringes is safer than drawing up medication in vials.” Just 11.94% disagreed.

Respondents said it was critically important to use a compounder when drugs are in short supply (52.08%) or if there were cost savings involved (30.61%). Just 16.33% cited time savings and 22% listed convenience as critically important reasons for buying prefilled syringes.

Justifying the move

One of the biggest obstacles to using prefilled syringes is cost. You’re virtually guaranteed to pay more when you buy medications in premixed, prelabeled syringes as opposed to traditional vials. But not all administrators see cost as prohibitive — especially when you add other factors into the equation.

“Generally, the [vials] are close to the cost of the compounded drugs. Add the safety into the equation, and the expense is justified,” says Donna Cairone, MHSA, BSN, RN, CNOR, RNFA, director of nursing at the Eye Surgery Center of Chester County in Exton, Pa.

The Carolina Ambulatory Surgery Center in Aiken, S.C., only uses compounded products on the most difficult cases. “If the cataract is diagnosed as 3+ NS or greater, or there is an underlying condition or cause for concern as to successful extraction, the physician will request the compounded product for use in the procedure,” says Christy K. Hutto, BSN, director of nursing. Several respondents cited drug shortages as the reason they turn to prefilled syringes. “We only buy medications that are unavailable,” says one. A director of anesthesia for a Nebraska-based hospital adds, “If we cannot get it any other way or it’s more cost-effective for prefilled, then we use it.” Perhaps Baylor Scott & White’s Ms. Schilthuis puts it best: “We need the drugs, or we can’t do the cases.”

In the end, respondents see an array of benefits ranging from increased safety and error reductions to consistent availability to ease of use, with the latter topping the list for many facility leaders. “The greatest benefit of prefilled syringes is they’re ready to go,” says Ray Pasion, RN, MSN, ASC administrator/clinical director at Precision Vision Surgery Center in Oklahoma City, Okla.

Some respondents cited the precision of using single-dose prefilled syringes as both a cost-saver and a compliance tool. The director of a Missouri-based surgery center touted the benefits of compounders for “satisfying requirements of single-dose meds.”

Ms. Hutto summarizes what prefilled syringes can potentially do for time-strapped facilities: “Using prefilled syringes doesn’t require the circulating nurse to draw up the compounded products into a syringe for injection in the OR, thus reducing the risk of cross-contamination or error. The medication is simply handed off to the scrub tech when the physician requests it or is ready to inject.”

Plus, as Ms. Hutto adds, there’s an often-overlooked benefit to prefilled syringes, as using them “cuts down on overall cost because we do not have to buy additional supplies (syringes, needles, alcohol pads) to prepare the compounded medications for injection.” OSM

The most common prefilled syringe is phenylephrine, followed by lidocaine, ephedrine, propofol and succinylcholine. Sheldon S. Sones, RPh, FASCP, a pharmacy consultant and safe medication management officer at more than 130 ambulatory facilities, says there are 4 compelling reasons these meds are purchased from compounding pharmacies:

• Ease of administration. Prefilled medications are easy for anesthesia to administer. Plus, these drugs minimize questions about sterile technique. When your staff is drawing up the syringes themselves, it’s a process that’s rife with potential problems. With prefilled syringes, you simply take off the cap and inject it, says Mr. Sones.
• Specific dosing needs. This is especially true in the case of intracameral ophthalmic drugs like moxifloxacin and cefuroxime where the dosing needs are very specific.
• Drug shortages. The top 5 medications from our survey have all been in short supply at one time or another.
• Expanded shelf life. In the case of prefilled succinylcholine, you can store the drug at room temperature for significantly longer than multi-dose vials: 90 days versus 14 days.

Respondents weighed in on other drugs they’re considering getting from a compounder. One was considering prefilled for “all meds that are multi-dose vials.”

Gina Schilthuis, RN, a clinical director at Baylor Scott & White Surgicare in Dallas, Texas, who already gets rocuronium, neostigmine and succinylcholine in prefilled syringes, might add Wydase (hyaluronidase).

Carrie Robertson, RN, BSN, nurse manager at Albuquerque (N.M.) Ambulatory Eye Surgery Center, might order vancomycin in a prefilled syringe. “We want to get away from us mixing it ourselves,” she says. “Also, our consultant pharmacist insists that we use one vial per patient — which is not going to happen. We are trying to find a way to satisfy the one-dose-per-patient rule.”

Our survey found facilities go with a compounding pharmacy primarily for safety, cost savings or because of a supply shortage. More than half (56.86%) of respondents said safety was a “critically important” reason for using a compounder. As Lakeside’s Ms. Bergeron puts it: “The cost is not that much more, and patient safety is more important than cost.” Ms. Bergeron isn’t alone with this sentiment. Most respondents viewed prefilled syringes as superior from a safety perspective — 59.70% either “strongly agree” or “agree” with the statement: “Buying prefilled syringes is safer than drawing up medication in vials.” Just 11.94% disagreed.

Respondents said it was critically important to use a compounder when drugs are in short supply (52.08%) or if there were cost savings involved (30.61%). Just 16.33% cited time savings and 22% listed convenience as critically important reasons for buying prefilled syringes.