Can Ready-to-Administer Syringes Improve Patient Care, Reduce Medical Errors, and Support a Greener Environment?

By Jason M. Erlich, MD

Daily challenges that face operating room (OR) teams throughout the country include promoting efficiency, minimizing strain on staff, and above all, preserving patient safety. A less frequently discussed detail is the massive amount of waste created by each OR case. One elegant solution to all four problems might lie in ready-to-administer (RTA) syringes.

As a replacement for the error-prone bedside act of drawing up medication from a glass vial, RTA syringe technology provides a prefilled polymer syringe that has a color-coded plunger, is prelabeled, and boasts an impressive shelf life. The time savings in providing busy clinicians with equipment requiring no preparation is self-evident. Further, an RTA syringe and its tamper-evident cap produces approximately half the medical waste compared to the bedside compounding of an individual vial of medication, which requires the vial, a needle, and a syringe, each with their associated packaging.

Though the discipline of anesthesia has been a leader in patient safety, medication errors continue to plague our perioperative workflow (Orser et al., 2001; Gordon et al., 2006). Study data shows us there is a problem, but the scope is sometimes difficult to define. For instance, a 2001 self-reported survey found that one out of every 133 patients undergoing anesthesia suffered a medication error, with 1% of those errors resulting in patient harm (Webster et al., 2001). The two largest error types were dosage errors (20%) and substitution errors of an IV bolus medication (20%). Within the substitution group, 69% were substitutions between medication classes, indicating an intent to perform one intervention but in fact using the wrong drug entirely.

Fifteen years later, a 2016 prospective observational study found that one in 20 perioperative medication administrations contained a medication error, with over one-third resulting in an observed adverse drug event (Nanji et al., 2016). Obviously, the error rate changed based on how we arrived at the tally, but the fact remains that our workflow is error prone.

To address the above, an RTA syringe platform can enhance patient safety by addressing the risk of vial- and syringe-swap medication errors as well as the risk of contamination when drawing medication out of a vial (Merry & Peck, 1995; Webster et al., 2001; Malik et al., 2022). While bedside compounding is part of our training, for decades we have accepted its associated risk. We may now be at an inflection point where we can leverage a technological advance in syringe design to provide error resistance to bedside compounding and thus protect the safety of our patients and ourselves.

RTA medications created in a sterile environment using vaccine manufacturing technology will not only provide clinicians with safer patient medications but will also combat staff injury in the form of repetitive stress to hands and wrists. Though poorly reported, anecdotal evidence suggests that hand and wrist injuries occur especially in high-turnover rooms where clinicians must administer multiple syringes of sedating medication in a short amount of time. This type of injury occurs at a rate of 46% among hospital-based RNs and represents an area where hospitals can do more to protect their staff from harm as well as improve efficiency (Dressner & Kissinger, 2018). To speak plainly, the “improved efficiency” we seek for anesthesiologists and certified registered nurse anesthetists (CRNA) is simply more distraction-free time at the bedside, which will mean improved vigilance over the well-being of our patients.

When considering the rest of the hospital, the availability of RTA medication in the ICU and emergency department (ED) can smooth the administration of anesthesia in settings that traditionally have less experience with intubation and sedation compared to the OR. Hence, the availability of RTA medication can help protocolize this important intervention and enhance patient safety by making clinician orders more accurate through the use of prefilled, prelabeled, and appropriately organized medication (Malik et al., 2022).

RTA medications can decrease the amount of in-hospital compounding performed in the pharmacy as well. Prefilled RFID-labeled syringes shipped from the manufacturer to the hospital pharmacy can go directly into a medication dispensary unit with the knowledge that concentration, tamper evidence, and potency are constant. Among the benefits an RTA platform offers to patients and staff are:

• Increased level of preparedness to deliver anesthesia in the OR, the ED, the ICU, and throughout the hospital
• Improved patient safety with color-coded plunger rods and clear labeling on syringes
• Error resistance in high-risk, acute care, and emergency areas of the hospital that need immediate access to medications
• Avoidance of repetitive stress injuries among staff and improved staff satisfaction
• Decreased bedside compounding and associated errors
• Potential reduction of medication-related OR waste

Patients, anesthesiologists, CRNAs, and the community outside the OR need a safer environment. Impactful innovations, such as anesthesia medications in a robust RTA syringe platform, can make a difference to safety, quality of care, and our stewardship of the planet.

Jason M. Erlich, MD, is an anesthesiologist and medical advisor to Genixus.

References

Dressner, M. A., & Kissinger, S. P. (2018, November). Occupational injuries and illnesses among registered nurses. Monthly Labor Review, U.S. Bureau of Labor Statistics. https://doi.org/10.21916/mlr.2018.27

Gordon, P. C., Llewellyn, R. L., & James, M. F. M. (2006). Drug administration errors by South African anaesthetists – a survey. South African Medical Journal, 96(7), 40. https://scholar.google.com/scholar_lookup?journal=South+Afr+J+Anaesth+Analg&title=Drug+administration+errors+by+South+African+anaesthetists+%E2%80%93+A+survey&author=P+Gordon&author=R+Llewellyn&author=M+James&volume=12&publication_year=2006&pages=40&

Malik, P., Rangel, M., & VonBriesen, T. (2022). Why the utilization of ready-to-administer syringes during high-risk situations is more important than ever. Journal of Infusion Nursing, 45(1), 27–36. https://doi.org/10.1097/nan.0000000000000451

Merry, A. F., & Peck, D. J. (1995). Anaesthetists, errors in drug administration and the law. The New Zealand Medical Journal, 108(1000), 185–187.

Nanji, K. C., Patel, A., Shaikh, S., Seger, D. L., & Bates, D. W. (2016). Evaluation of perioperative medication errors and adverse drug events. Anesthesiology, 124(1), 25–34. https://doi.org/10.1097/aln.0000000000000904

Orser, B. A., Chen, R. J., & Yee, D. A. (2001). Medication errors in anesthetic practice: A survey of 687 practitioners. Canadian Journal of Anaesthesia, 48(2), 139–146. https://doi.org/10.1007/bf03019726

Webster, C. S., Merry, A. F., Larsson, L., McGrath, K. A., & Weller, J. (2001). The frequency and nature of drug administration error during anaesthesia. Anaesthesia and Intensive Care, 29(5), 494–500. https://doi.org/10.1177/0310057×0102900508