• Yushi Yang, Antonia Joy Rivera, Christopher R Fortier, and James H Abernathy.
• From the Department of Industrial Engineering, Clemson University, Clemson, South Carolina (Y.Y.); Department of Information Management Services, Children's Hospital of Wisconsin, Milwaukee, Wisconsin (A.J.R.); Department of Pharmacy, Massachusetts General Hospital, Boston, Massachusetts (C.R.F.); and Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, Charleston, South Carolina (J.H.A.).
• Anesthesiology. 2016 Apr 1; 124 (4): 795-803.

BackgroundPrefilled syringes (PFS) have been recommended by the Anesthesia Patient Safety Foundation. However, aspects in PFS systems compared with self-filled syringes (SFS) systems have never been explored. The aim of this study is to compare system vulnerabilities (SVs) in the two systems and understand the impact of PFS on medication safety and efficiency in the context of anesthesiology medication delivery in operating rooms.MethodsThis study is primarily qualitative research, with a quantitative portion. A work system analysis was conducted to analyze the complicated anesthesia work system using human factors principles and identify SVs. Anesthesia providers were shadowed: (1) during general surgery cases (n = 8) exclusively using SFS and (2) during general surgery cases (n = 9) using all commercially available PFS. A proactive risk assessment focus group was followed to understand the risk of each identified SV.ResultsPFS are superior to SFS in terms of the simplified work processes and the reduced number and associated risk of SVs. Eight SVs were found in the PFS system versus 21 in the SFS system. An SV example with high risk in the SFS system was a medication might need to be "drawn-up during surgery while completing other requests simultaneously." This SV added cognitive complexity during anesthesiology medication delivery. However, it did not exist in the PFS system.ConclusionsThe inclusion of PFS into anesthesiology medication delivery has the potential to improve system safety and work efficiency. However, there were still opportunities for further improvement by addressing the remaining SVs and newly introduced complexity.

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