Hospital Pharmacy Europe
Prefilled contrast media syringes simplify the tasks associated with contrast injection in computerised tomography (CT) technology, especially since the introduction, in 1998, of multidetector CT (MDCT).(1) Prefilled syringes have a set volume and concentration of contrast agent in a power injector-compatible syringe. They are considerably easier to use than bottle-filled cartridges and reduce the possibility of contamination or misadministration.(2) It has been shown that most CT technologists prefer prefilled syringes (PFSs) to bottle-filled cartridges (BFCs), believing them to be safer and more efficient.
Prefilled syringes vs bottle-filled cartridges
A multicentre time-and-motion analysis was carried out to assess the efficiency of using PFSs.(2) Four hundred power injector contrast-enhanced CT examinations were monitored at four major hospitals to study the relative efficiency of PFSs and BFCs.(3)
The BFC method involves tearing the seal off a vial of contrast medium, drawing the contrast into a syringe compatible with a power injector, labelling the syringe according to guidelines and disposing of the used supplies. Using a PFS involves selecting the syringe, removing the rubber safety cap and installing the syringe in the injector head. Care must be taken in both methods to expel any air before administering contrast to the patient.
In this study, CT technologists who participated were interviewed about their experience and impressions of each method. As expected, PFSs showed the greatest time savings over BFCs for activities most closely dependent on the contast method used, such as contrast loading time and disposal of supplies/injector cleanup. Recorded examination times were, overall, approximately 9% shorter in the PFS group compared with the BFC group, which can be explained by the slightly increased proportion of inpatient examinations performed using BFCs.
The greatest gain in efficiency came from the contrast loading time. Overall setup time and overall patient time, which are measures progressively less sensitive to factors related to contrast administration, show smaller efficiency gains overall.
A 3% increase in overall efficiency was demonstrated to be due to the use of PFSs, a finding which is consistent with the 33% decrease observed in injector loading time. In addition, room setup efficiency increased by 10%.
These findings suggest that the use of PFS can potentially increase CT department throughput while improving technologists’ satisfaction levels. If the time saved by using PFSs is used to perform additional examinations, the revenue generated might offset or exceed the incremental cost of converting to prefilled contrast media syringes.
The role of the pharmacist in prefilled syringes procurement
In line with the UK government’s emphasis on improving the quality of care and patient safety,(4–6) the pharmacy profession is currently focusing attention on reducing errors associated with medicines use. A recent article has described how the assessment of medicines tendered for local and national purchasing contracts in secondary care has been developed to introduce a national approach to risk assessment.(7) The aim of the risk assessment strategy is to ensure that products with apparent inherent risks are not purchased. Part of this risk assessment strategy is concerned with the potential for a medication error to occur.(8)
To aid pharmacists in the assessment of products such as prefilled contrast media syringes at the purchasing stage, a risk assessment tool has been developed in the UK.(7) It includes a medication error potential analysis in the form of a scored or weighted checklist designed to identify the areas of risk associated with the medicines labelling and packaging.
The factors considered include:
- Mistaking the medicine with another product due to poor labelling or packaging.
- Mistaking the medicine with another due to similarity of the manufacturer’s packaging across its product range.
- Mistaking the medicine with another product when it has been removed from its outer packaging.
- Continously using a medicine outside its licensed indicators.
- Providing the incorrect dose due to complex manipulations before administration.
- Providing the incorrect dose due to poor or insufficient technical data.
The overall risk for each product is reported to the contracting team. Purchasing decisions are then made on the basis of the risk rating and evidence of errors in practice. An important part of the process is to communicate the findings to the Medicine and Healthcare products Regulatory Agency (MHRA), National Patient Safety Agency (NPSA) and the manufacturer to allow labelling and packaging improvements to be made.
Optiray(®) (Tyco/Mallinckrodt) contrast media is available in a broad range of iodine concentrations and prefilled packaging.(9) Optiray® 300 and 350 are injectable low-osmolar, nonionic, contrast media agents that are intended for intravascular administration. Both products are intended to be therapeutically and biologically inert when injected into the body for use in organ or tissue enhancement in CT, X-ray and fluoroscopy imaging procedures.
Optiray is available in Ultraject(®) prefilled hand-held and power injector syringes. PFSs are prelabelled to minimise the risk of misadministration due to unlabelled or mislabelled syringes. They are efficient due to shorter procedure preparation time, and because contrast is always ready when needed. PFS minimise the possibility of contamination by maintaining sterility while eliminating the need for glass, vials, bottles and filling syringes. They also reduce the likelihood of exposure to punctures and cuts from contaminated sharps, metal rims or broken glass. Ultraject can be put back in stock for future use if a procedure is cancelled, rather than disposed of, and it has a two-year shelf-life, for long-term storage.
In March 2006, at the European Congress of Radiology (ECR) in Vienna, 470 questionnaires were randomly distributed amongst the congress participants.(10) The surveyed sample represented 29 countries, mainly from Europe, and 360 questionnaires were completed and returned (response rate 76%). Seventy-eight percent of respondents were radiologists and 16% were radiographers/technicians.
The majority of respondents had had work experiences of more than 10 years in hospital sizes of more than 250 beds. Amongst those who had had experience with prefilled contrast products, 87% found that their department efficiency had increased with the use of prefilled products, and 91.1% thought that the use of prefilled products was safer for patients. Thirty-six point one percent said that, even if vials (BFCs) were cheaper, the benefits of PFSs were worth the cost, while 20.3% said they would return to using BFCs if they were much cheaper and 9.8% saying that they would never use BFCs again.
Pharmacists should have a key role in the ordering, stocking and dispensing of radiographic products, examining where these products are being stored throughout the facility, the ease with which they can be accessed, ordering procedures and the manner in which they are distributed.
- Rubin GD. Techniques for performing multidetector-row computed tomography angiography. Tech Vasc Interv Radiol 2001;4:2-14.
- Enterline DS. A multicenter time-efficiency trial. Imaging Economics 2003. Available from: http://www.imagingeconomics.com/issues/articles/2003-02_13.asp
- Enterline DS. Multicenter evaluation of prefilled contrast media syringes versus bottle filled cartridges for contrast-enhanced CT examinations using time-motion efficiency and technologist opinion survey. Oral communication, RSNA 2003, Chicago.
- Department of Health. An organisation with a memory.London: The Stationery Office; 2000.
- Department of Health. Building a safer NHS for patients – implementing an organisation with a memory. London: The Stationery Office; 2001.
- Department of Health.Building a safer NHS for patients – improving medication safety.London: The Stationery Office; 2004.
- NHS Pharmaceutical Quality Assurance Committee. Quality assurance and risk assessment of licensed medicines for the NHS.1st ed; 2004.
- Beaumont IM, Ireland DS, Taylor J.Purchasing medicines for safety: risk assessing labelling and packaging. Available from: http://www.saferhealthcare.org.uk/IHI/Topics/MedicationPractice/CaseStudies/PurchasingMedicines.htm
- ThreePharm Medical. News. Available from: http://www.threepharm.ro/medical/news.php?lang=EN
- The use of contrast media in pre-filled syringes: what is your opinion? Tyco Healthcare/Mallinckrodt EMEA.