14-day expiration date. If a compounder draws succinylcholine up, the
drugs will remain stable for 6 weeks.
That 6-week stability also helps us manage our drug inventory with
greater precision. Let's say we order 25 prefilled syringes of succinyl-
choline and we use 14 syringes in 15 days. We order 25 more, which
arrive 3 days later, leaving us with 36 syringes: 11 expiring in 2 to 4
weeks, and the rest expiring on their "beyond-use date" in 4 to 6
weeks. With our system of just-in-time inventory, we're never caught
shorthanded without needed medications and, just as important, our
drugs never expire on the shelves. If a compounder can show a drug
is stable for 45 days, it can label the drug with a 40-day expiration
date.
Getting started
Many perioperative drugs are available in prefilled syringes, including
anticoagulants, some antibiotics, pain relievers (both opioids and non-
opioids), heparin flushes and saline flushes. You may also be able to
order customized prefilled doses of medications from your com-
pounder.
About a month after our hospital opened, in 2013, we started buy-
ing 5 commonly used medications in premixed ready-to-use syringes
from a compounding pharmacy: neostigmine, succinylcholine,
phenylephrine, prediluted ephedrine and rocuronium. We didn't have
a clean room to prepare IV medications and we wanted to reduce the
possibility of medication errors. Plus, our anesthesiologists were
requesting specific concentrations of drugs. We didn't want them dis-
tracted with dilutions and calculations in order to draw up medica-
tions in the OR when they should be monitoring patients — especial-
ly the anesthesiologist who told us, "I'm not good at math."
We foresaw several problems with anesthesiologists mixing drugs
4 6 • O U T PA 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 1 7
