As technological advances ensue in the medical field, medical specialists continue to improve upon historical processes for delivering healthcare. For anesthesiologists, issues around access and delivery of essential medications are critical to the discussion of innovation. In many medical centers across the nation, the vial-and-syringe technique is predominant in the operating room. In this method, anesthesiologists or clinically-trained Certified Registered Nurse Anesthetists (CRNAs) carefully transfer the assigned and coded medications from the vial, or a large quantity manufacturer container, to the syringe, a small unit of medication that is then administered directly to the patient. However, inherent in this process is a degree of waste. Along with medical waste, there is also an economic impact to the system. Underscoring each of these items is an effect on resource utilization at the hospital level, elucidating the argument for anesthesia professionals to transition from a vial to a pre-filled syringes system of care delivery.
To commence, the historical utilization of vials over syringes results in direct medical waste, impacting the patient, practitioner, and hospital. Upon transferring the medication from the vial to the syringe, often the entire quantity of medication in the vial does not divide evenly among the syringe. Thus, for each vial that is transferred to one or multiple syringes, a small amount of the medication is then left in the vial and disposed as biomedical waste. Medical waste impacts the patient because it requires a greater number of vials for the same net value of medication, resulting in a higher ratio of medical waste to patient. For the practitioner, the use of vials to syringes also has an effect on time. The anesthesiologist must include the conversion as an item on his or her roster of tasks, while the CRNA, nurses, or related operative staff must also ensure this is completed as a line item. Of course, the medical waste to the system is important to note because it reduces the level of efficacy and operative excellence. Rather than the vial-to-syringe method, pre-filled syringes would mitigate the level of waste by promoting a quantity-limited, separate amount of medication per patient and per procedure — allowing anesthesia management to streamline operative processes.
In addition to the operative benefits of reducing medical waste, there is also a strong cost consideration for adhering to pre-filled syringes. This cost impact may be viewed in terms of direct cost, or the dollars allocated to the drug itself, along with the indirect cost, or the number of allocated hours that clinicians devote to preparing medications. Numerous studies have indicated that pre-filled vials reduce the amount of preparation time per vial, while also minimizing the error impact during surgery.
Patient safety is also a strong concern, particularly in critical surgical cases that anesthesia providers may encounter. A study from the Journal of Patient Safety found that pre-filled syringes reduces patient risk, including that of dosage errors and contamination, and it also resulted in a reduction of healthcare practitioner errors, such as needle stick injury. Based on this seminal study, additional case reports, and institution cost-analyses, experts agree that pre-filled syringes are necessary to continue advancing patient care and safety from anesthesiologists and CRNAs perspective.
Moving forward, anesthesiologists, CRNAs, and other anesthesia care professionals should strongly consider pre-filled syringes as a technique to optimize care for all patients across institutions and centers of care.