Prefilled syringes have always been a safe, economic and convenient way to administer medications. Now they're even safer, thanks to clearer labels, high-tech tracking capabilities and tamper-proof caps that lower risks of medication errors, cross-contamination and drug diversion. Check out the following safety-minded features found on prefilled syringes that have been designed to help you deliver the right dose of the right drug to the right patient every time.

1. Syringe tracking

Consider this scenario: One of your compounders has recalled 1 lot of a 10 ml, 25% dextrose syringe because of a testing issue, and now your facility needs to pull it from your stock. Wouldn't it be nice to know exactly how many syringes from that specific lot you have and where they are in your inventory? Take that one step further — what if you could identify every patient who had already received the dextrose injection and inform them that the lot is being recalled?

You can. In the past few years, some compounders have started producing prefilled syringes equipped with a radio frequency identification (RFID) tag on the syringe's label. You load the tagged syringes onto a medication tray and scan each tray with an accompanying RFID scanning system. In about 5 seconds, the system reads each RFID tag and uploads that information to special computer software.

The software tracks information about each syringe, says John Karwoski, RPh, founder of JDJ Consulting in Wenonah, N.J. That information includes everything from the syringe's lot number to its expiration date.

If you get notified about a recall, the software can quickly tell you which syringes are from the affected lot and in which tray they're being stored. There's also a possibility that, as the technology develops, it will be able tell you which patients the syringes were used on, so you can alert them as well.

An added bonus: The software can alert you when the expiration date for a syringe is approaching, says Mr. Karwoski. "(Facilities) can determine which syringes' dates are coming due in their databanks," he says.

2. Barcode scanning

For facilities that don't have the computer software capable of reading RFID tags, there's an easier, more basic method of tracking prefilled syringes: barcode scanning.

Drug manufacturers assign individual barcodes to each prefilled syringe. The barcode contains information on the strength and expiration date of the drug. Before using a syringe, you first run the barcode through special scanning technology, which confirms that you've grabbed the right medication and the right dose.

"You pick up a syringe filled with 10 mg of morphine and scan it," says Allen Vaida, PharmD, executive vice president at the Institute for Safe Medication Practices (ISMP). "If it's 20 Mg of morphine, it's not going to scan."

The same is true if it's the wrong type of medication or the drug's expiration date has passed, according to Mr. Vaida, who says some companies have a slightly different take on barcoding technology with platforms that confirm you're using the right drug and dose.

3. Tamper-proof caps

Some prefilled syringes feature tamper-proof caps to reduce the risk of drug diversion. The caps work like this: After the syringe has been compounded and filled, the drug manufacturer affixes a cylindrical hard plastic top. After that top is taken off the syringe, it can't be put back on.

"It's like buying a soda and breaking the seal," says Mr. Karwoski. "If that cap is removed, it can't be replaced."

Tamper-proof caps aren't new — many companies market caps for vials that can be crimped over the plastic vial seal, allowing you to flip the top of the cap off to reveal the seal underneath. But, unlike syringe tamper-proof caps, the vial caps can come off and, "it doesn't necessarily mean that someone's entered the vial," says Mr. Karwoski. With tamper-proof prefilled syringe caps, there's no doubt the syringe has been used.

4. Clearer labeling

Prefilled syringes in general have done a lot to cut down on the safety issues associated with drawing up a syringe, but nothing is immune to human error. It's easy to confuse similar sounding or looking syringes, especially when there are many types of medications on the sterile field and you're rushing more than you should.

That's why manufacturers and organizations like ISMP have started using clearer labeling systems to help you tell the difference between syringes.

? Tall man lettering. One of the most popular ways to make medication labels easier to read is by writing medication names with lower- and upper-case letters, differentiating between similar sounding drugs, so you won't give a patient a medication to treat cardiac arrest (epinephrine) when you meant to give them one that would raise their blood pressure (ephedrine). With tall man lettering, ephedrine is written as "ePHEDrine" and epinephrine is written as "EPINEPHrine." That format highlights the difference between the medications' names and downplays their similarities (-rine).

The use of tall man lettering has been increasing in popularity over the past 10 years, especially with the advent of prefilled syringes, says Mr. Vaida. Now, manufacturers can create labels for prefilled syringes using tall man lettering. The syringes arrive at your facility with the tall man lettering already on their labels.

? Colored-coded labels. Other advances in labeling reduce the likelihood of mixing up syringes that contain similar medications. One that's gained in popularity in recent years is color-coded labels, says Sheldon Sones, RPh, FASCP, president of Sheldon S. Sones and Associates, a pharmacy and accreditation consulting firm based in Newington, Conn.

Compounders use a specific color on syringe labels to differentiate classes of drugs. For example, a blue label might indicate an opioid, a yellow label would be used on an induction agent and a bright red label would identify a neuromuscular blocker.

The colored labels are a fast, eye-catching way to identify the right class of drug you're looking for, but they can come with their own set of problems, says Mr. Vaida.

"Color coding was more effective many years ago, when there were only a few types of each drug," he says. "But now, for example, there are numerous opioid and neuromuscular blockers."

That can be a problem if you're in a rush and mean to grab the 2 mg/ml morphine syringe with a blue label, but instead grab the 4 mg/ml hydromorphone syringe with the same color label.

Mr. Vaida suggests using colored labels to differentiate syringes by strength, rather than drug class. That way, when you're reaching for a syringe, you can find the strength you need first, then ensure you're grabbing the right kind of drug in that strength category.

A smarter choice

Prefilled syringes also generally reduce contamination errors that can occur when you're drawing up a drug, says Steve Vitcov, MD, medical director at Presidio Surgery Center in San Francisco, Calif.

In addition to the clear safety benefits associated with pre-filled syringes, Dr. Vitcov says the devices provide financial and ecological benefits. Instead of opening a 200-mg vial, you can order exactly the 140-mg syringe that you need, which saves you money. On top of that, the remaining 60 mg of a drug in that single-use vial is unusable and will need to be disposed. That's not the case if you're using the exact amount of a medication you ordered, says Dr. Vitcov.

It's clear that choosing prefilled syringes is the safer — and smarter — choice. OSM