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Evidence-based Practice and Quality Improvement

Evaluation of the atropine wastage in a french university hospital: the benefit of the extemporaneous preparation or pre-filled syringes


Loupec, T.; Loosfeld, F.; Frasca, D.; Debaene, B.

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European Journal of Anaesthesiology (EJA): June 2013 - Volume 30 - Issue - p 21-22
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Background and Goal of Study: Atropine syringes are routinely prepared in each operating room to quickly treat any bradycardia. When there are not used, these syringes are thrown at the end of the day. Extemporaneous preparation (EP) or pre-filled syringes (PFS) of atropine may contribute to health savings.

The aim of the study was to assess the actual cost of the routine preparation (RP) of atropine syringes and to assess the potential savings with different modes preparations.

Materials and Methods: In a first part of the study, the RP cost of atropine syringes was estimated retrospectively for the year 2010. The use of atropine in pediatric surgery and for neuromuscular blockade reversal were excluded. In a second part, 39 anesthesiologists, residents, nurse anesthetists and student nurse anesthetists took part in a simulated intraoperative bradycardia. Time for preparing an atropine syringe of 0.5 mg was recorded according to 2 scenarios (S):

S1, 2 vials of 0.25 mg/ml and sampling equipment available on a sterile tray;

S2, 1 vial of 0.5 mg/ml and sampling equipment available on a sterile tray.

The cost of atropine preparation with PFS was estimated by Aguettant.

Results and Discussion: In 2010, 7835 syringes of atropine were routinely prepared at the opening of the operating rooms. Only 1223 syringes were used, it equals 611.5 mg of atropine for € 1015.1 and a waste of € 5488.1.

Mean preparation time ± SD (range) for scenarios S1 and S2 were 26.5 ±7.9 (17-60) and 18.1 ±3.5 (10-25), respectively (p< 0.01). The spending distribution for the syringe preparation according to the proposed methods is shown in Table 1, without taking into account manpower cost and waste disposal and treatment.

[Table 1. Preparation cost of atropine syringes]

Conclusion(s): RP of atropine syringes represents a significant wastage. PFS are immediately available and allow estimated health savings of 34.2%. EP with atropine vial of 0.5 mg/ml (S2) are performed in a mean time lower than 20 seconds and would make savings of 87.8%.

© 2013 European Society of Anaesthesiology