Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
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• Time. You shouldn't opt for prefilled syringes simply because they're convenient and your staff doesn't feel like diluting and labeling medications. But in many cases that convenience translates directly into significant savings. The time spent set- ting up, diluting, drawing and labeling medications is money — especially for busy outpatient centers where shaving precious minutes off turnover times can lead to additional cases. "If your anesthesia providers spend a minute or two preparing drugs, and your goal is sub-20-minute turnover times, prefilled medications can be a dif- ference-maker," says Dr. Wehling. • Safety. The outpatient surgical environment is built on a culture of speed and efficiency — factors that can increase the risk of medication errors involving potent drugs with specific dosage and usage requirements. Medication errors are rare but catastrophic when they do occur, says Allen J. Vaida, BSc, PharmD, FASHP, executive vice president at the Institute for Safe Medication Practices (ISMP). "A high-profile incident will cost you a lot of money [in legal fees] and subject your facility to bad publicity," says Dr. Vaida. He remembers a case involving a patient who was under general anesthe- sia and had his knee injected with epinephrine from an unlabeled syringe, which providers mistakenly thought was filled with a local anesthetic. The patient went into pulmonary arrest and ultimately died because of the error. Many drug administration mistakes occur because anesthesia providers are tasked with drawing medications into syringes and labeling them with no oversight in place, according to Dr. Vaida. About five years ago, he asked 1,400 facilities to conduct a self- assessment of their medication safety practices. Fewer than 75% of the facilities said their providers always labeled syringes. Buying prelabled syringes from a reputable compounding pharmacy eliminates errors linked to improper medication labeling practices and helps to ensure providers administer the right dose of the right drug to the right patient. • Waste. Years ago, it was common practice for facilities to use multidose vials for multiple cases. Dr. Vaida says the practice is now prohibited by infection control policy makers, accreditation agen- cies and CMS. Discarding the trace amounts of medications left in multidose vials can add up to significant waste and, depending on the amount, a single-dose prefilled option may be the cheaper option. For example, Dr. Wehling found that pre- filled 50 mg/mL ketamine syringes were economi- cally beneficial for his facility when he looked at waste associated with a multidose option. • Diversion. Wasting unused medications is a safety imperative that must be documented each time it's done — especially when dealing with highly addictive controlled substances — because drug diversion is an increasing threat in the midst of the nation's opioid crisis. In the past, when Dr. Vaida conducted medication risk assessments at hospitals and surgery centers, he'd ask the staff one pointed question: Have you had any medication errors? If they said no, he'd tell them they weren't looking hard enough. These days, he's added a new question to the mix: Do you have a problem with diversions? 5 2 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • A U G U S T 2 0 2 0 READY TO GO Prefilled syringes are available in the most frequently used dosages of drugs, which lets you avoid the waste and potential safety concerns associated with other delivery methods.