by Arthur Wallace, M.D., Ph.D. and Alfred Wallace
Drug substitution errors are common and can lead to significant
morbidity and mortality. Improved drug labeling has been identified
by the Joint Commission on Accreditation of Healthcare Organizations
(JCAHO) as a way to reduce drug errors and reduce risk. There is
a new JCAHO mandate that all syringes must be labeled with the drug
name, concentration, the date and time, and the person preparing
the medication. This labeling takes time and it is difficult to write
legibly on the label on a syringe. The curved surface of the syringe
and the required small print is difficult and time consuming. Compliance
with this new mandate is difficult. We developed a simple, inexpensive,
rapid, easily customizable system of labeling that fulfils the JCAHO
drug labeling requirements.
The system consists of a set of Microsoft Word (Microsoft Redmond
WA) files formatted to print on Avery Laser and Inkjet White Address
Labels (Avery No. 5167) (Avery Office Products, Brea, CA) (0.5 inch
by 1.75 inch labels in 100 label per sheet). We use the Skilcraft
generic equivalent labels to save cost. The labels cost $25.80 per
package of 100 sheets (8,000 individual labels). The Avery version
costs $43.27 for 100 sheets. Each custom file has the drug name,
drug concentration, date, time, and clinician’s name. The current
date and time are automatically filled in by Microsoft word on printing.
Individual clinicians can modify the sheet to have the set of most
commonly used drugs. We have one set that is used most commonly for
non-cardiac cases, and one set that is used for cardiac cases, but
the sheets can be modified easily by the clinician for the specific
drugs they use. One advantage of the system is that all clinicians
prepare drugs in the same concentration in the same syringe size
because the labeling mandates the concentrations.
The labels are printed in color on a Xerox Phaser 8500/N color laser
printer. Anesthesia technicians print the files for the clinicians
working each day at 6:30 am. They then put the sheet of labels on
the anesthesia cart in the OR for each clinician for the day. The
sheets have enough labels for at least four cases per room. At the
end of the day the sheets are discarded and a new sheet prepared
the next morning. The clinicians prepare drugs using the label when
they set up for the day. The system is simple, inexpensive, easily
customizable, and fits all JCAHO requirements.
Instructions for use:
1. Download the MS Word file here --> Art
Wallace Drug Labels 8167 V5.
2. Open the file in Microsoft Word, if it does not open automatically.
3. On the EDIT menu select FIND and REPLACE
4. In the 'Find What' box, type <Art Wallace, M.D.> and in the
'Replace With' box type < your name>.
5. Click Replace All. It should replace 80 names on the 80 labels.
6. Save the file on your Desktop or somewhere you will easily find it.
7. On the morning of surgery, open the file and print it. We have a work
room technician print everyone's labels at once and then place them on
the clinician’s cart in the OR. The date and time will be updated automatically
to the current date and time on your computer.
1. We place the files on a network drive that is accessible to
all. The clinicians can then customize the files to their needs
2. We try to have all the same colors for classes of drugs. We turned
down the color intensity on the FORMAT, BORDERS and SHADING, SHADING,
MORE COLORS, CUSTOM using the triangular slider on the right side to
cut the cost of the color printing.
3. We try to have all drugs mixed with the standard concentrations and
volumes to avoid confusion.
Coming soon! Individual labels and batch printed
sheets can be printed using a Visual Basic Program (Microsoft Corp,
Redmond WA) that we have developed. It prints the label sheets for
the clinicians working on that day from the database. The program
also prints single drug labels on the Dymo Labelwriter 400 printer
(Dymo Corporation, Stamford, CT) which can be placed in each operating
room for printing a single label if it is needed.