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standards from USP 797, which require hospitals and ambulatory
surgical centers to include a considerable amount of information
on syringe labels, including the beyond-use date and time. Many
centers find it difficult to fit all of the information on the syringe.
Prefilled syringes are CMS-labeling compliant. In addition, they
come complete with an anti-tamper cap, making diversion
increasingly difficult.
Begin with a few frequently used medications. Determine your
acquisition cost for each drug and current utilization volume. For
example, if you purchase 100 vials of neostigmine a year, that
would equate to 100 doses administered per year, since each vial
is single-patient use. Compare the cost of 100 vials vs 100 pre-
filled syringes to determine the potential for savings. Remember
to consider preparation time when calculating savings: drawing
the medication, the syringe itself, swabbing, labeling and staff
hours all contribute to the cost of preparing that syringe. Once
calculated, you can use that figure to perform a cost-benefit
analysis for the purchasing of vials compared to prefilled
syringes. Be sure to ask your 503B sterile re-packager about
contract pricing through your group purchasing organization.
Where to begin when transitioning to prefilled syringes? I
suggest starting with a top 3 to 6 common medications —
propofol, phenylephrine and succinylcholine, for example —
that demonstrate the greatest savings in terms of shelf life by
virtue of their stability at room temperature.
— John Karwoski, RPh, MBA
Mr. Karwoski (jkrpmba@me.com) is the president and founder of JDJ
Consulting, a pharmacy consulting company in Wenonah, N.J.
