Communication has always been a crucial part of exceptional patient care. Given the current climate of long hours and clinician burnout, it’s only become more important. When patients receive intravenous therapy, miscommunications can have dire effects. IV line drug labels can help keep your team on the same page and help ensure your patients receive the proper medication.
The goal is to supply the correct medication to the correct patient at the correct time. Labels are a critical tool to capture and communicate this kind of information.
Caresfield recently co-hosted a CaresTalk webinar, Wraparound IV Line Drug Labels, Harnessing Best Practices to Improve Patient Safety with the American Society of Health-System Pharmacists (ASHP). Caresfield Vice President of Sales and Marketing Stefanie Bosshart, Ph.D. led the discussion with special guest Michael Ganio, Pharm.D., M.S., BCSCP, FASHIP, ASHP Senior Director, Pharmacy Practice and Quality. The duo looked at current industry standards and recommended best practices health systems could use to standardize labels.
Medication Errors: More Common Than You Think
Hospital medication errors in the U.S. can range significantly, sometimes as often as 1 in 5 doses1. While medication is administered through various mechanisms, intravenous therapy is a common method. In a review of 91 direct observation studies of medication errors in UK hospitals and long-term care facilities2, investigators reported in the Annals of Pharmacotherapy that intravenous administration yielded an error rate of 53 percent3.
With up to 80 percent of hospital patients receiving intravenous treatment during their stay4, these error rates can be devastating. In fact, the Institute for Safe Medication Practices (ISMP) lists one of the Top 10 medication hazards to be unsafe practices associated with IV push medications. Is your team doing everything possible to reduce the risk of these IV line medication errors and associated adverse drug reactions?
The goal is to supply the correct medication to the correct patient at the correct time. Thus, labels are a critical tool to capture and communicate this kind of information.
Labels Can Help
The Joint Commission sees effective line labeling as a critical part of safety5. When multiple lines are used for a patient, there is added complexity for caregivers administering the medication. It’s important that practices and processes are in place in to support consistency. Preventing line mix-ups and labeling high alert/high risk medications may improve patient safety and help meet Joint Commission standards.
The Intsitute for Healthcare Improvement suggests placing labels on each distal port and the tubing6. They also suggest that labels should look different between each line. This typically comes back to color or size of the label. Manufacturers can customize label designs with different colors, letting, fonts, sizes and coatings.
Color’s Role on IV Line Labels
Color has long been used to aid in the classification and identification of medications. However, the drawback with IV line labels is that there is not an official standard that exists as it does with anesthesia syringes.
“There is a school of thought that the use of color may conversely lead to errors within classes because caregivers may become overly reliant on color,” Bosshart said. “Unfortunately, there isn’t strong data or a controlled study to look at this tradeoff definitively. As a manufacturer, we do see color used commonly on these types of labels.”
Tall Man Lettering and Font Size
Tall man lettering may also be used to reduce the risk of look-alike and sound-alike drugs being mixed up. But again, there is not a definitive single source on tall man lettering. The Food and Drug Administration (FDA) provides a baseline with The FDA Name Differentiation Project. More standardization comes from other organizations like ISMP with a list of Look-Alike Drug Names with Recommended Tall Man Letters.
Labels can also enhance the visibility or legibility of critical information and drug names with text font and size, as well as the size of the label. However, no standard exists for these sizes either.
Lastly, the durability of labels is extremely important. Errors may be more prevalent when labels fall off the line or when text smudges from contact with alcohol or hand sanitizer. Solutions like an alcohol resistant coating can help prevent smudging, but typically adds to the cost of the label.
Whatever standardization strategy you implement, it is critical to include an ongoing employee education and awareness campaign. We’ve observed facilities we’ve worked with on standardizing IV line labels take this approach with success.
What We See as a Manufacturer
With all customizations and strategies, it’s probably no surprise that manufacturers see inconsistency across the industry. A single health system or integrated delivery network may have a half dozen or more different labels meant for the same purpose spread across departments or sites. These labels vary by color, size and lettering. Not only does it create major inventory inefficiencies, but this may be creating patient safety risks. It is especially difficult for staff members moving between departments or facilities.
“A recent use case led us to work with ASHP,” Bosshart said. “A leading health system in the South created a task force to standardize IV line labels for infusions across several departments and sites. Their aim was to standardize these labels per the American Society for Anesthesiologist’s Statement on Creating Labels of Pharmaceuticals for Use in Anesthesiology, a guideline document for syringe medications, to increase safety and to streamline their centrally managed inventory.”
After several meetings and a collection and categorization of all the currently used labels, Caresfield created a file of recommended standardizations. That task group reviewed the first draft and provided feedback. At this point, Caresfield approached ASHP to review and compile final recommendations.
ASHP Review
Dr. Ganio and ASHP reviewed 63 labels for size of label and text, tall man letter and the color of the label background and text. To ensure the labels follow best practices, they used the following standards:
- American Society of Anesthesiologists: Statement on Labeling of Pharmaceuticals for Use in Anesthesiology
- ASTM D4774-11: Standard Specification for User Applied Drug Labels in Anesthesiology
- ISO 26825: Anesthetic and respiratory equipment – User-applied labels for syringes containing drugs used during anesthesia – Colors, design and performance
- FDA Name Differentiation Project: FDA List of Established Drug Names Recommended to Use Tall Man Lettering (TML)
- ISMP:
Some of the association’s recommendations were subtle. For instance, unless called for by tall man letting standards, you should not capitalize the first letter of each label. One of the key elements for identifying look-alike and sound-alike drugs is tall man lettering, or capitalizing key differences in drug names. By not capitalizing the first letter, labels make tall man lettering more effective, and may help clinicians identify the correct medication.
Other recommendations included ways to streamline labels. For example, on the label “cisatracurium besylate,” Dr. Ganio points out that it’s besylate doesn’t really add anything because it’s not something clinicians say. Printing just cisatracurium on the label makes it easier to read and identify. Similarly, Dr. Ganio recommends standardizing to generic names.
“Some drugs do have multiple brand names,” Dr. Ganio said. “Using a single recognizable name rather than a brand name helps Caresfield standardize and streamline production.”
Removing Colors and Confusion
Beyond standardizing names, Dr. Ganio recommends removing colors that could cause confusion. He used blinatumomab as an example. Originally printed in yellow to indicate hazardous waste, Dr. Ganio points out that not every institution considers blinatumomab to be hazardous. In this case, ASHP recommended removing the color to make it a standard white label.
Finally, Dr. Ganio suggested removing several labels. The labels for “electrolytes” and “buffered 3%,” were not specific and could apply to multiple medications. To protect patient safety, it’s best to avoid these labels.
At the end of the review, several labels remained colored based on ASTM and ISO color recommendations. Not surprisingly, labels that did not fit within the standards were left colorless with proper tall man lettering. These labels are all using generic drug names with no salts listed.
“It’s all the information you need to know what drug is in that line,” Dr. Ganio said.
The final recommendation also included several auxiliary alert labels.
“In the end, we believe this methodical approach with the aid of Dr. Ganio’s team resulted in improved inventory management through the standardization of many part numbers,” Bosshart said. “As well as an increased potential to enhance patient safety.”
Get Started Today
Both Caresfield and ASHP are here to support standardization efforts for your IV line labels. Caresfield offers free consultations with Certified Label Healthcare Technicians. These non-disruptive visits will allow us to see what labels and printers you currently use, so we can make an exact match for your system.
Once we know your exact needs, we will work with ASHP to ensure your labels align with ASTM, ISO, ISMP and FDA standards and guidelines. Caresfield will manage the review, so you can focus on your patients!
Related: Caresfield Labels: Convert and Save Money
Sources
- Medication Errors Observed in 36 Health Care Facilities, JAMA
- Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence, National Library of Medicine
- Intravenous Therapy, BMJ Journals
- Medication Administration Errors, Patient Safety Network
- National Patient Safety Goals® Effective January 2021 for the Ambulatory Health Care Program, The Joint Commission
- Reduce Adverse Drug Events Involving Intravenous Medications, Institute for Healthcare Improvement
