| Safety syringes: How to
evaluate options that get directly to the point
by Jean McDowell, vice president of
clinical affairs, Inviro Medical Devices
W ith a proliferation of
safety syringe designs crowding the market, it can be difficult to get
directly to the point that matters most: which syringe offers the
ideal combination of benefits to your employees and patients? The
decision can be complex. Armed with the right information, however,
you can guide the decision-making team to the medical device that best
protects and serves your organization.
Safety first
Two safety issues are critical to consider:
needlestick injuries and medication errors. The former, of course, is
the reason safety syringes were developed. The Needlestick Prevention
Act, which was passed in 2000, requires healthcare providers to review
and update their exposure control plans, maintain a log of needlestick
injuries, and evaluate and implement the provider’s choice of safety
syringe and needleless systems. As a result, all healthcare facilities
are now required to perform annual safety product reviews, which
encompass safety syringes. In addition to purchasing or materials
management professionals, the evaluation team should include
representatives from infection control and occupational health – and
the law mandates that frontline nurses have input.
Despite manufacturing advances, according to the
2006 Study of Needlestick Injuries and Safety Devices (an
independent study sponsored by Inviro Medical Devices), 70 percent of
nurses and 94 percent of directors of infection control surveyed say
they still worry about accidental needlestick injuries among
clinicians. Meanwhile, 64 percent of nurses surveyed report that
they’ve experienced accidental needlesticks, and 82 percent of
directors surveyed believe accidental needlestick injuries remain a
significant and serious hazard. Continued injury reduction should be a
priority for any team evaluating product options.
Medication errors are another concern facing our
industry, and it is appropriately gathering enormous momentum with
patient advocacy groups and politicians. Proper syringe labeling
certainly plays a role in whether patients receive the right
medication and the correct dose. While manufacturers, pharmaceutical
firms and hospitals grapple with developing labeling systems, for
injectable medications, this issue can be closely tied to the syringe
design itself. Having critical information recorded directly onto the
syringe – and ensuring it remains intact – is essential. It’s the last
point in an involved information transfer process before injecting the
patient.
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Inviro Medical’s InviroSNAP! safety syringe |
The 2007 Study of Injectable Medication Errors,
developed and co-sponsored by the American Nurses Association (ANA)
and Inviro Medical Devices, found that 93 percent of nurses believe
integrating a write-on field on a syringe barrel could decrease
incidents of medication errors. The first safety syringe with this
unique feature is available on the market today. Such technology also
helps organizations comply with The Joint Commission’s 2007 and 2008
National Patient Safety Goals which recommend health facilities label
all medications and medication containers, e.g., syringes, medicine
cups and basins. As you examine which safety syringes to purchase for
your institution, the ability to help address medication errors should
now be a crucial component of the dialogue.
New technologies: A primer
At first glance, it may be difficult to distinguish
between the myriad of safety
syringes available to healthcare organizations. Nursing and infection
control leaders, who have long advocated for protection of healthcare
workers, recommend a framework that divides the current options into
three distinct market segments:
• Retro-fitted: A conventional syringe with an add-on
piece, such as a cap, sheath or shield that covers the needle.
• Automatically retractable: A spring-activated safety
syringe that automatically draws the needle back into the syringe
barrel after use.
• Manually retractable: Operates with a simple "Push,
Pull, Snap" mechanism to manually withdraw the needle into the syringe
barrel and snap off the plunger.
Retro-fitted syringes
Retro-fitted designs were the first form of safety
syringe, introduced as manufacturers scrambled to help hospitals meet
the mandates of the Needlestick Prevention Act. These designs add a
safety mechanism to a standard syringe. The device used to cap the
needle may be attached to the needle itself – or to the syringe. The
added mechanism can get in the way of giving the injection and, upon
activation, can place a clinician’s fingers dangerously close to the
exposed needle – exactly the problem they were created to avoid.
Therefore, many end users considered them unsatisfactory. Sometimes
clinicians remove the safety mechanism or don’t activate it,
eliminating its protective qualities. The primary advantage
retro-fitted syringes offer: they meet regulatory requirements, and
they are often the least expensive option.
Automatically retractable syringes
Automatically retractable designs work like a
ballpoint pen; the needle automatically retracts into the syringe
barrel. However, such devices may fail if used incorrectly, and they
can aerosolize if retraction is activated outside of the patient. In
addition, automatically retractable safety syringe designs are often
significantly more expensive than other options. Of the devices
currently available on the market, these are the easiest to operate,
but the most expensive. For this reason, many institutions seek
products from other categories.
Manually retractable syringes
Manually retractable syringes are the latest product
evolution, particularly one that incorporates a write-on stripe to
address medication labeling. While manually retractable syringes have
the appearance of a conventional syringe, these devices offer some of
the advantages of the automatically retractable products. The safety
mechanism is integral to the syringe and functions with a simple
"Push, Pull, Snap." After pushing to complete the injection, the
clinician pulls the plunger back, retracting the needle into the
syringe barrel. Snapping off the plunger completes the process,
permanently disabling the syringe to prevent possible re-use and
reducing volume for the sharps container. Because the clinician
controls the mechanism at all times, there is a lower risk of
aerosolization. The user’s hands always remain out of the way of the
needle, making it easier to administer injections and further reducing
the risk of needlestick injuries. In addition, manually retractable
syringes may be more cost-effective than automatically retractable
syringes.
Selecting sharps
When determining which safety syringe works best for
your institution, look for medical devices that protect both patients
and healthcare workers. Use safety issues as a starting point. Two key
questions to consider:
• Will this design help reduce needlestick injuries?
• Does this design lower the risk of medication errors
associated with syringe labeling?
As you examine available safety syringes, be sure to
include at least one choice from each of the three market segments:
retro-fitted, automatically retractable and manually retractable. That
way, you’ll ensure a real choice.
The following questions may help your team further
distinguish the pros and cons of each product line:
• Does it have easy-to-read gradation markings?
• Are designs available with low dead space?
• Does the manufacturer offer a range of syringe
sizes?
• Can the syringe accommodate a variety of needle
sizes?
• Are low dose options available – particularly for
syringes to be used for insulin?
• What is the cost?
• What is the cost / benefit ratio when factoring in
employee and patient safety?
Altogether, these factors will influence your decision
and help drive
you to selecting the safety syringe that offers the ideal combination
of benefits.
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