that could have led to patient harm. For example, we didn't want
anesthesia providers prescribing, preparing and administering med-
ications with no double-check. We also didn't want to risk incomplete
syringe labels — the anesthetist might have included the drug name,
but not necessarily other important details, such as drug concentra-
tion or expiration date. And then there was the problem of what to
do if the drugs the anesthesiologists prepared were not administered
during the case? Take atropine, for example, which is often prepared
for emergent situations. If it wasn't used, it would either be discarded
or inappropriately kept beyond the expiration for use on subsequent
cases.
If you decide to buy prefilled syringes, we strongly encourage you
to visit the manufacturer. Our vendor invited us to tour their factory
in Houston. The 4-hour drive was well worth it. We came away thor-
oughly impressed and convinced that there was no way we could
achieve their level of cleanliness and automation. The machines and
testing equipment, the UV lights, temperature and humidity controls,
HEPA-filtered rooms — it assured us that we weren't going with
another NECC (New England Compounding Center). They also let
us watch them preparing a batch of drugs online. We were able to
A U G U S T 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 4 9
form a calculation.
4. If shelf life will be longer. If the prefilled manufacturer's
beyond-use date (BUD) for a refrigerated item is significantly
longer than the manufacturer's expiration date, go prefilled. If a
manufacturer's BUD is 14 days and the compounder's is 6 weeks,
you have 4 extra weeks of stability during which you can use that
product.
— Joshua Montney, PharmD, MBA, BCPS,
and Johnathan E. Stinnett, CPht
