Title : The financial and environmental cost of anaesthetic emergency drugs: Comparing ampoules with prefilled syringes a second cycle quality improvement project
Abstract:
Anaesthetic emergency drugs are essential for safe practice; however, many prepared drugs remain unused and are disposed of daily. Prefilled syringes (PFS) may reduce medication errors and waste although are associated with increased costs.[1] Cycle 1 of our project found 48.1% of prepared emergency drugs were wasted producing 3,372kgCO2e a year.[2] Substituting PFS for metaraminol, ephedrine, and atropine, predicted a 22% saving annually. Cycle 2 was undertaken following substitution to assess real-world outcomes.
Methods: A survey was distributed to nine theatres at Queen Elizabeth the Queen Mother (QEQM) hospital examining the use and waste of emergency drugs. Anaesthetic teams were encouraged to complete these throughout February 2024 and 2025 for cycles 1 and 2 respectively. Annualised use and waste of drugs were estimated with costs of ampoules, PFS, equipment, and sharps bin disposal, provided by hospital pharmacy, suppliers, and facilities teams. Ampoules and equipment were weighed and kgCO2e (CO2 equivalent) estimated using emission factors per NHS spend and waste incineration.[3]
Results: Cycle 2 provided 87 surveys representing 270 cases. 82.5% fewer emergency drugs were wasted with a waste reduction of 48.1% to 8.4% contributed to by greater utilisation percentages for PFS. The annualised cost of waste reduced by 91.1% from £23,348 to £2,080. Weight of waste reduced by 93.0% from 196.8kg to 13.8kg contributing to a 91.3% reduction in kgCO2e from 3,372 to 294kgCO2e. The cost-analysis of replacing metaraminol, ephedrine, and atropine ampoules with PFS using local tariffs estimated a 31.6% saving of £14,042.
Discussion: PFS for metaraminol, ephedrine, and atropine, are estimated to have saved 31.6% at one hospital site, predominantly through producing less waste. This exceeded expectations of 22%, partially contributed to by a change in practice with less emergency drugs such as glycopyrrolate being routinely prepared. Limitations included self-reported data, relying on NHS-specific conversion factors, generalisability between hospitals, and lacking the human cost of potential medication errors. Despite these limitations, PFS are highly likely to provide a cost, environmental, and safety benefit to patients, the trust, and planet
