The wrong drug problem continues

The important components of safe anaesthetic practice identified include organisational structure with strategic control of healthcare delivery, teamwork and leadership, evidence-based practice, proficiency, continued professional development of all staff, and well-embedded incident reporting and adverse events’ disclosure systems. In our quest for the safest possible health care, there is a need for prospective observational multidisciplinary (anaesthetists and human factors specialists) studies as distinct for retrospective reports of adverse events. There is also need for research to establish the ideal system architecture for anonymous reporting of near miss and no harm events in anaesthetic practice.

The important components of safe anaesthetic practice identified include organisational structure with strategic control of healthcare delivery, teamwork and leadership, evidence-based practice, proficiency, continued professional development of all staff, and well-embedded incident reporting and adverse events' disclosure systems. In our quest for the safest possible health care, there is a need for prospective observational multidisciplinary (anaesthetists and human factors specialists) studies as distinct for retrospective reports of adverse events. There is also need for research to establish the ideal system architecture for anonymous reporting of near miss and no harm events in anaesthetic practice.
There is an increasing recognition that medication errors are causing a substantial global public health problem, as many result in harm to patients and increased costs to health providers. [3] However, study of medication error is hampered by difficulty with definitions, research methods and study populations. Few doctors are as involved in the process of prescribing, selecting, preparing and giving drugs as anaesthetists, regardless of whether their practice is based in the operating theatre, critical care or pain management. Anaesthesia is now safe and routine, yet anaesthetists are not immune from making medication errors and the consequences of their mistakes may be more serious than those of doctors in other specialties.
Steps are being taken to determine the extent of the problem of medication error in anaesthesia. New technology, theories of human error and lessons learnt from the nuclear, petrochemical and aviation industries are being used to tackle the problem.
Safe drug administration is the responsibility of health care providers and drug regulatory authorities. Medication errors are an inevitable consequence of the human condition; they occur even among the most conscientious medical professionals. If health care professionals do not demand, on behalf of their patients, reasonable safeguards to reduce the likelihood of medication errors, no one else will. Health care professionals should report their concerns regarding the quality, safety, performance or design of products used in their practice to the authorities. These authorities need to identify the underlying causal mechanisms and develop strategies to prevent their recurrence. This information is then shared with industry and appropriate government agencies.
Proper IV administration should follow the five "rights" of medication administration to avoid medication errors: be sure it is the right patient, the right drug, the right dose, the right time, and the right route before giving any medication. Sir, I read with interest the correspondence by Singh et al. [1] titled "The wrong drug problem continues". Medication error is a leading cause of morbidity and mortality in hospitalised patients. Due to high potency, variety and frequency of drugs administered to patients undergoing anaesthesia, the potential for errors exists, with disastrous consequences. The major cause of drug error is misidentification of drug ampoules or vials. Confusing, inaccurate or incomplete labels contributed to 21% of the actual or potential drug errors reported to the US Pharmacopoeia practitioners network over a one-year period (1999). [2] The American Society of Anaesthesiologists supports the manufacture and use of pharmaceuticals with labels meeting standards that are consistent with those established by the American Society for Testing and Materials (ASTM) International.
The main change to the drug label is the introduction of a critical information panel or field. The label presents the generic name of the drug, the total amount per total volume and the drug concentration in black text on a white background. In addition, the drug's proprietary name, manufacturer, lot number, date of manufacture and expiry date should also be included on the label.
The text on the label should be designed to enhance

Local anaesthetics Grey
Anticholinergic agents Green the recognition of the drug name and concentration as recommended in the ASTM International standards. [3] Maximum Contrast between the text and the background should be provided by high contrast colour combinations, as specified in section 6.3.1 of the ASTM International Standards, which also minimise the impact of colour blindness [3] [ Table 1].
Nine classes of drugs commonly used in the practice of anaesthesiology have a standard background colour established by the ASTM International standards for user-applied syringe labels. For these drugs the colour of the container top, label border and any other coloured area on the label, excluding the background, as required for maximum contrast; should be the colour responding to the drug's classification. [3] [ Table 2] Essential information including the drugs generic name, concentration and volume of the vial or ampoule should be bar coded at a location on the vial or ampoule, which will not interfere with the labels legibility as specified in the ASTM International Standards. [4] As described by Singh  Sir, Induction of anaesthesia with thiopental sometimes leads to bronchospasm especially in patients with a history of bronchial asthma. Although bronchospasm with thiopental is a rare phenomenon, it can be catastrophic if it occurs. Mechanism of bronchospasm with thiopental can be manifold. We report a case of severe intraoperative bronchospasm following induction of anaesthesia with thiopental.
A 24-year-old female presented in emergency department with breast abscess, for emergency incision and drainage procedure. The patient gave a history of childhood asthma but was completely alright for the last 15 years. The patient also gave a history of few seizure episodes in past for which she did not take any treatment. In the emergency ward intravenous line was established and intravenous