Skip to main content
SpringerLink
Log in

Standardised drug labelling in intensive care: results of an international survey among ESICM members

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

Standardised coloured drug labels may increase patient safety in the intensive care unit (ICU). The rates of adherence to standardised drug syringe labelling (DSL) in European and non-European ICUs, and the standards applied are not known. The aim of this survey among ESICM members was to assess if and what standardised drug syringe labelling is used, if the standards for drug syringe labelling are similar internationally and if intensivists expect that standardised DSL should be delivered by the pharmaceutical industry.

Methods

A structured, web-based, anonymised survey on standardised DSL, performed among ESICM members (March–May 2011; Clinicaltrials.gov NCT01232088). Descriptive data analysis was performed and Fisher’s exact test was applied where applicable.

Results

Four hundred eighty-two submissions were analysed (20 % non-European). Thirty-five percent of the respondents reported that standardised drug labelling was used hospital-wide, and 39 % reported that standardised DSL was used in their ICU (Europe: Northern 53 %, Western 52 %, Eastern 17 %, Southern 22 %). The International Organization of Standardization (ISO) 26825 norm in its original form was used by 30 %, an adapted version by 19 % and local versions by 45 %; 6 % used labels that were included in the drug’s packaging. Eighty percent wished that the pharmaceutical industry supplied ISO 26825 norm labelling together with the drugs.

Conclusions

Standardised DSL is not widely applied in European and non-European ICUs and mostly does not adhere strictly to the ISO norm. The frequency and quality of DSL differs to a great extent among European regions. This leaves much room for improvement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Tissot E, Cornette C, Demoly P, Jacquet M, Barale F, Capellier G (1999) Medication errors at the administration stage in an intensive care unit. Intensive Care Med 25:353–359

    Article  PubMed  CAS  Google Scholar 

  2. Valentin A, Capuzzo M, Guidet B, Moreno R, Metnitz B, Bauer P, Metnitz P (2009) Errors in administration of parenteral drugs in intensive care units: multinational prospective study. BMJ 338:b814

    Article  PubMed  Google Scholar 

  3. Franklin BD, Taxis K, Barber N (2009) Parenteral drug errors. Reported error rates are likely to be underestimation. BMJ 338:b1814

    Article  PubMed  Google Scholar 

  4. Calabrese AD, Erstad BL, Brandl K, Barletta JF, Kane SL, Sherman DS (2001) Medication administration errors in adult patients in the ICU. Intensive Care Med 27:1592–1598. doi:10.1007/s001340101065

    Article  PubMed  CAS  Google Scholar 

  5. van den Bemt PMLA, Fijn R, van der Voort PHJ, Gossen AA, Egberts TCG, Brouwers JRBJ (2002) Frequency and determinants of drug administration errors in the intensive care unit. Crit Care Med 30:846–850

    Article  PubMed  Google Scholar 

  6. Wheeler SJ, Wheeler DW (2005) Medication errors in anaesthesia and critical care. Anaesthesia 60:257–273. doi:10.1111/j.1365-2044.2004.04062.x

    Article  PubMed  CAS  Google Scholar 

  7. Orser BA, Chen RJ, Yee DA (2001) Medication errors in anesthetic practice: a survey of 687 practitioners. Can J Anaesth 48:139–146. doi:10.1007/BF03019726

    Article  PubMed  CAS  Google Scholar 

  8. Puttick N (2003) A response to ‘Syringe labelling in critical care areas, Souter A, Anaesthesia 2003; 58:713. Anaesthesia 58:1149

    Article  PubMed  CAS  Google Scholar 

  9. Parry M, Morris S (2007) Critical incident involving syringe labels. Anaesthesia 62:95–96 (discussion 96). doi:10.1111/j.1365-2044.2006.04924_1.x

    Google Scholar 

  10. Webster CS, Anderson D, Murtagh S (2001) Safety and peri-operative medical care. Anaesthesia 56:496–497

    Article  PubMed  CAS  Google Scholar 

  11. Sybrecht GW, Prien T (2010) Arzneimittelsicherheit: standard-Spritzenaufkleber in der Akutmedizin. Deutsches Ärzteblatt 107:A-1031/B-907/C-895

  12. The Joint Commission (2010) National patient safety goals 2010. http://www.jointcommission.org/standards_information/npsgs.aspx. Accessed 12 July 2011

  13. Mellin-Olsen J, Staender S, Whitaker DK, Smith AF (2010) The Helsinki declaration on patient safety in anaesthesiology. Eur J Anaesthesiol 27:592–597. doi:10.1097/EJA.0b013e32833b1adf

    Article  PubMed  Google Scholar 

  14. Moreno RP, Rhodes A, Donchin Y (2009) Patient safety in intensive care medicine: the declaration of Vienna. Intensive Care Med 35:1667–1672. doi:10.1007/s00134-009-1621-2

    Article  PubMed  Google Scholar 

  15. Hellier E, Edworthy J, Derbyshire N, Costello A (2006) Considering the impact of medicine label design characteristics on patient safety. Ergonomics 49:617–630. doi:10.1080/00140130600568980

    Article  PubMed  CAS  Google Scholar 

  16. Gitlow S (2004) Report 5 of the Council on Scientific Affairs 2004. http://www.ama-assn.org/resources/doc/csaph/a04csa5-fulltext.pdf. Accessed 12 July 2011

  17. American Society for Testing and Materials International (1995) ASTM D4774-11 Standard specification for user applied drug labels in anesthesiology. Philadelphia. doi:10.1520/D4774-11

    Google Scholar 

  18. Standards New Zealand (1996) User-applied labels for use on syringes containing drugs used during anaesthesia (AS/NZS 4375:1996), Wellington, New Zealand

  19. Canadian Standards Association (1998) Standard for user applied drug labels in anaesthesia and critical care (Z264.3-98:1998), Etobicoke, Canada

  20. Bhuskute N, Earl D Syringe labelling in critical care areas. http://www.rcoa.ac.uk/docs/ARB-new_syringe-labelling.pdf. Accessed 12 July 2011

  21. Sybrecht GW (2010) Empfehlung zur Kennzeichnung von Spritzen in der Intensiv- und Notfallmedizin. Anasth Intensivmed 6:371–374

    Google Scholar 

  22. Prien T (2009) Empfehlung der DGAI zur farbigen Kennzeichnung von Spritzen. Anasth Intensivmed 5:333–334

    Google Scholar 

  23. World Health Organization (2011) Regional Committee for Europe. http://www.euro.who.int/en/who-we-are/governance/regional-committee-for-europe. Accessed 12 July 2011

  24. Baba R, Ravalia AS (2004) International colour coding for syringe drug labels: a survey. Anaesthesia 59:1033. doi:10.1111/j.1365-2044.2004.03952.x

    Article  PubMed  CAS  Google Scholar 

  25. Gordon PC, Llewellyn RL, James MFM (2006) Drug administration errors by South African anaesthetists—a survey. S Afr Med J 96:630–632

    PubMed  CAS  Google Scholar 

  26. Levrat Q, Troitzky A, Levrat V, Debaene B (2008) Enquête nationale sur le marquage des seringues d’anesthésie en France (Syringe drug labels: a French national survey). Ann Fr Anesth Reanim 27:384–389. doi:10.1016/j.annfar.2008.04.003

    Article  PubMed  CAS  Google Scholar 

  27. Jensen LS, Merry AF, Webster CS, Weller J, Larsson L (2004) Evidence-based strategies for preventing drug administration errors during anaesthesia. Anaesthesia 59:493–504. doi:10.1111/j.1365-2044.2004.03670.x

    Article  PubMed  CAS  Google Scholar 

  28. Porat N, Bitan Y, Shefi D, Donchin Y, Rozenbaum H (2009) Use of colour-coded labels for intravenous high-risk medications and lines to improve patient safety. Qual Saf Health Care 18:505–509. doi:10.1136/qshc.2007.025726

    Article  PubMed  CAS  Google Scholar 

  29. Erbe B (2011) Safe medication administration in the operating room. Tar Heel Nurse 73:10–13 (quiz 14)

    Google Scholar 

  30. Jennings J, Foster J (2007) Medication safety: just a label away. AORN J 86:618–625. doi:10.1016/j.aorn.2007.04.003

    Article  PubMed  Google Scholar 

  31. Institute for Safe Medication Practices (2003) ISMP Medication Safety Alert, 23. Huntington Valley, PA

    Google Scholar 

  32. Shannon J, O’Riain S (2009) Introduction of “international syringe labelling” in the Republic of Ireland. Ir J Med Sci 178:291–296. doi:10.1007/s11845-009-0342-4

    Article  PubMed  CAS  Google Scholar 

  33. Souter A (2003) Syringe labelling in critical care areas. Anaesthesia 58:713. doi:10.1046/j.1365-2044.2003.32672.x

    Article  PubMed  CAS  Google Scholar 

  34. Brown-Brumfield D, DeLeon A (2010) Adherence to a medication safety protocol: current practice for labeling medications and solutions on the sterile field. AORN J 91:610–617. doi:10.1016/j.aorn.2010.03.002

    Article  PubMed  Google Scholar 

  35. Merry AF, Shipp DH, Lowinger JS (2011) The contribution of labelling to safe medication administration in anaesthetic practice. Best Pract Res Clin Anaesthesiol 25:145–159. doi:10.1016/j.bpa.2011.02.009

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful that this survey has been endorsed by the European Society of Intensive Care Medicine (ESICM). We specially thank Prof. Jean-Daniel Chiche, ESICM president-elect, for his support.

Conflicts of interest

The authors do not report any financial support or sponsorship, or other conflicts of interest.

Author information

Authors and Affiliations

  1. Department of Anaesthesiology and Intensive Care Medicine, Campus Charité Mitte and Charité Campus Virchow-Klinikum, Charité—University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Felix Balzer, Claudia Spies, Marc Kastrup & Willehad Boemke

  2. Division of Anaesthesiology, Department of Anaesthesiology, Intensive Care and Clinical Pharmacology, University Hospitals of Geneva, Geneva, Switzerland

    Nadine Wickboldt, Bernhard Walder & Jérôme Goncerut

  3. Department of Anesthesia, Hospital San Gerardo, Monza, Italy

    Giuseppe Citerio

  4. Department of Intensive Care Medicine, St. George’s Healthcare NHS Trust, St. Georges University of London, London, UK

    Andrew Rhodes

Authors
  1. Felix Balzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nadine Wickboldt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Spies
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bernhard Walder
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jérôme Goncerut
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Giuseppe Citerio
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Andrew Rhodes
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marc Kastrup
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Willehad Boemke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Willehad Boemke.

Additional information

F. Balzer and N. Wickboldt contributed equally.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (JPEG 176 kb)

Supplementary material 2 (JPEG 212 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balzer, F., Wickboldt, N., Spies, C. et al. Standardised drug labelling in intensive care: results of an international survey among ESICM members. Intensive Care Med 38, 1298–1305 (2012). https://doi.org/10.1007/s00134-012-2569-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-012-2569-1

Keywords

Search

Navigation