by Arthur Wallace, M.D., Ph.D. and Alfred
Easy-print version here
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
Corp, Redmond WA) files formatted to print on Avery Laser
and Inkjet White Address Labels (Avery No. 5167) (Avery
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
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, title>.
5. Click Replace All. It should replace 80 names on the
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
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
to their needs and preferences.
2. We try to have all the same colors for classes
of drugs. We turned down the color intensity on
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
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.