Prefilled Syringes Are the Preferred Choice

Supply Management

By: Sheldon Sones

Published: 4/8/2021

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Waste reduction, time-savings and increased safety are among the benefits of purchasing preloaded medications.


If you're considering prefilled syringes for your facility, a little perspective goes a long way. It doesn't make sense to do an apples-to-apples cost comparison of prepackaged medications with vial-filled versions of the same drugs. There are several indirect and intangible benefits to the prefilled syringe equation, and until you've examined them from all angles, you aren't going to get a full picture of how ready-to-administer meds contribute to cost-effective, efficient and safe patient care.

  • Waste reduction. Prefilled syringes often cost more up front per milliliter than manufactured medications, but that's not always the case if you factor in waste amounts and extended beyond use dates (BUDs). Compounding pharmacies' BUDs for some items are significantly longer than drug manufacturers' expiration dating. Succinylcholine is just one example. This commonly used muscle relaxant must be used in a fairly short time frame — 14 days — if it's purchased from a drug manufacturer. But prefilled syringes of purchased from a compounding pharmacy can be stored at room temperature for 90 days or more.

    • It's also important to consider that multiple-dose vials should not be used for more than one patient, meaning you're often forced to discard at least some unused medication at the end of case. If you're regularly wasting even half of the medications you purchase, chances are prefilled syringes will be less costly and more efficient in the long run. When you consider these factors, the gap shrinks between the cost of prefilled syringes and manufactured medications.

    • Significant time-savings. Anesthesia providers appreciate working with prefilled medications — and for good reason. The medications come prelabeled, which eliminates the time-consuming task of drawing up — and sometimes diluting — medications as well as complying with necessary labeling requirements for syringes prepared at the surgical site.

    In my role as a pharmacy consultant, I observe the types of medications facilities tend to purchase in prefilled syringes. The most common options tend to be emergency drugs that facilities like to have ready for immediate administration such as rocuronium, succinylcholine, ephedrine and phenylephrine. A variety of ophthalmic medications such as moxifloxacin and cefuroxime used for intracameral administration that require very specific dosing are also commonly bought in prefilled syringes. An added benefit of getting ophthalmic drugs from a compounder: They tend to be products that cannot be reliably duplicated without a lot of preparation and effort.

    EXPIRATION EXTENDER Prefilled syringes of succinylcholine can be stored at room temperature for 90 days or more, compared to 14 days for the multi-dose version.
    • Superior safety. When your providers mix and label medications in-house, the responsibility of ensuring safe medication practice rests entirely with your facility. However, when you enlist the services of a reputable compounding pharmacy, it's responsible for the integrity, potency, stability and sterility of the medications it provides. That's why it's essential to research your options and partner with a reputable 503B compounding pharmacy with a proven track record of success.

    It's understandable why some facilities and providers might still have reservations about collaborating with a compounding pharmacy after contaminated medications prepared by the New England Compounding Pharmacy caused the 2012 meningitis outbreak that killed 64 patients and sickened hundreds more. Since that tragedy, however, the FDA has done everything possible to mitigate safety concerns about compounding pharmacies through comprehensive, on-site inspections and standard compliance reviews. Ultimately, however, it's up to you to do your due diligence into any compounding pharmacy with which you're thinking of working.

    To research the reputation of compounding pharmacies, start with the American Society of Health System Pharmacists (ASHP), which offers a number of references — such as the ASHP Guidelines on Outsourcing Sterile Compounding Services (osmag.net/S9SUbb) — and position statements at no charge, as well as a number of additional tools that are available to members of the organization.

    Another valuable tool is the FDA's compounding pharmacy inspection data. The FDA is an open book when it comes to its inspections and publicly lists any discrepancies it finds — large or small — during the inspection process, which has raised the bar for quality standards among compounding pharmacies. An important note: the FDA's inspections list every ding, no matter how slight. You need to understand the differences between major problems that should be a deal-breaker and minor issues that shouldn't automatically disqualify a potential compounder.

    SUPPLY AND DEMAND Compounding pharmacies can provide access to needed therapies during nationwide shortages of essential medications.   |  Pamela Bevelhymer

    At the end of the day, patient safety is the ultimate goal. And the fact of the matter is pre-mixed, pre-labeled medications from a well-vetted compounding pharmacy are generally safer and more precisely prepared than many medications mixed in the OR — especially at high-volume facilities where staff are under a lot of pressure to keep the surgical schedule on track and limit turnover times between cases.

    • Shortage prevention. Even when medications are in short supply, you can often still procure them through a compounding pharmacy. I've worked with compounders who have stepped up to get facilities the medications they need, even during significant shortages involving key drugs such as midazolam and fentanyl and some ophthalmic products that are always in high demand.

    Tipping the scales

    The decision to opt for prefilled syringes ultimately comes down to understanding your facility's short- and long-term needs. In the final analysis, for many leaders, the multiple benefits of buying prepackaged medications tips the scales favorably toward these products. Prefilled syringes provide the advantage of immediate access, no provider labeling, extended expiration dates (in certain cases), medication quantities that meet your facility's specific needs and robust FDA oversite of standards compliance. After weighing all the factors, particularly for emergency medications and ophthalmic preparations, you'll find this option more attractive than it might have appeared at first glance. OSM

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