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thinks prefilled syringes reduce waste and therefore can be more cost-effective in the long run. When Dr. Wahr puts a healthy, young patient to sleep, she draws up a syringe of phenylephrine, in case the patient's blood pressure falls. If the blood pressure remains stable throughout the procedure, she has to throw away the syringe at the end of the case and draw up a new one for the next patient. "A prefilled syringe, however, can stay in the anesthesia cart until its needed," she says. "All I have to do is open a drawer, take off the cap and give it to the patient." You should also consider the positive impact prefilled syringes can have on staffing expenses. Your medication budget may take a hit on the front end when you purchase prefilled syringes, but labor costs will fall over the long run. "If anesthesia providers spend 15 minutes per case drawing up medica- tions and work six cases a day, that's a lot of time and money," says Dr. Wahr. "Over the course of a year, those minutes and dollars add up." Safer, streamlined care 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 neostig- mine," she explains, "but instead pick up the neuro- muscular 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 mas- sive overdose, and died." Dr. Wahr says prefilled syringes contain the cor- rect concentrations of medications, which elimi- nates 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 mis- D E C E M B E R 2 0 2 0 • O U T P A T I E N T S U R G E R Y . N E T • 6 1 EXTRA STEP Drawing up and diluting drugs takes time and increases the likelihood of mistakes being made. Pamela Bevelhymer