The Perks of Prefilled Syringes

Dr. Wahr is a huge advocate of prefilled syringes because they can significantly reduce the risk of medication errors. "Before cases, we individually open five or six vials and draw the medications into syringes, which creates the possibility of syringe swaps or substitution errors," she says.

One of the most common syringe swaps happens at the end of the case, when the anesthesiologist needs to reverse the effects of the paralytic drug, according to Dr. Wahr. "They intend to give neostigmine," she explains, "but instead pick up the neuromuscular blocker rocuronium."

Although drug substitution errors might not happen as often as syringe swaps, Dr. Wahr says they tend to have far more drastic consequences. "In one case, an anesthesiologist thought he was giving doxapram, but actually picked up a vial of dopamine," she recalls. "The patient ended up receiving undiluted dopamine, which was a massive overdose, and died."

Dr. Wahr says prefilled syringes contain the correct concentrations of medications, which eliminates the risk of these sorts of errors, especially if a medication vial has to be diluted.

Another nice thing about prefilled syringes is that they're barcoded. Several manufacturers now offer barcode readers that communicate directly with electronic anesthesia records. When you scan the barcode on a syringe, the system speaks the drug's name aloud and displays the name on a screen.

"We know from cognitive science that our brain loves to work in the subconscious —what we call system one-type thinking," says Dr. Wahr. "That's how you tie your shoes and sometimes how you drive to work. You often don't consciously think about either task because your subconscious brain is running a schema you've done hundreds of times, and your conscious brain does not have to be involved. The downside is that the subconscious brain takes shortcuts. If it was expecting to see one thing and sees something else, it will often override what's there."

That phenomenon can cause devastating mistakes during drug administration. A barcode scanning system with an auditory component can provide an extra sense of security against the subconscious brain taking over. When you sweep the barcode on a medication label, and see and hear the drug's name, a second sense is involved. Your subconscious brain could potentially override a visual cue, but the auditory component provides a backup of sorts. "Activating two senses is like having two people double-checking your work," says Dr. Wahr.

Dr. Abernathy points out prefilled syringes streamline the workload of anesthesia providers, who can therefore spend more time focusing on patient care. "The less medication prep you have to do, the more attention you pay to the case, and the less likely you are to make a mistake," he says.

Prefilled syringes are ready to administer and eliminate the risk of substitution and swap errors.

If you spend a lot of time drawing up, reconstituting and diluting drugs, while also caring for patients, you're increasing your cognitive workload. "If all you have to do is grab a prefilled syringe, all of that work is already done for you, so your cognitive load goes way down," says Dr. Abernathy. "Your opportunities for error go down as well."

Having to draw up five or six syringes for each case takes several minutes, and eats into OR turnover times. Anesthesia providers who don't want to keep busy surgeons waiting might rush to get syringes ready, and accidentally skip a crucial step in the medication preparation process. "We don't know how to teach our subconscious brain to not make mistakes," says Dr. Wahr. "Telling providers to try harder or to focus more doesn't work. We need stronger interventions, and certainly prefilled syringes is one of them."

Many anesthesia providers love prefilled syringes because they make their jobs a bit easier, says Dr. Abernathy. When they're under a time crunch to get medications ready for the next case, they simply open a drawer on the anesthesia cart and grab the needed syringes. That eliminates having to open numerous vials, draw medications into syringes and label them all correctly.

Ultimately, prefilled syringes help to reduce the human factor in medication errors, keep patients safer and providers happier, which, in a time of such stress and uncertainty, are invaluable benefits. OSM