International Colour Coding for syringe drug labels: a survey

It is strongly recommended to read carefully the label on any drug ampoule or syringe before a drug is drawn up or injected to avoid injection of the wrong drug [1]. A standardised colour code for user-applied syringe labels for anaesthetic drugs exists in the USA, Australia, New Zealand, South Africa and Canada [2]. The United Kingdom traditionally had an assortment of colour codes for syringe labels. As a part of the Department of Health's drive to minimise drug administration errors in critical areas, the Councils of the Royal College of Anaesthetists, the Association of Anaesthetists of Great Britain and Ireland, the Faculty of Accident and Emergency Medicine and the Intensive Care Society recommended the adoption of the International Colour Coding System for syringe labelling on or after May 2003 [3]. Operating theatres were the first clinical area expected to adopt the International Colour Code labels. We introduced the International Colour Coding System throughout our hospital immediately after the recommendations were made. However, we recently realised that, despite advice to the contrary, our day surgery unit had some of the old labels still available. We undertook a telephone survey of 60 randomly chosen Anaesthetic Departments in the United Kingdom (a mixture of teaching and district general hospitals) to establish the syringe drug labelling system currently in use in all their operating theatres. We interviewed the senior Operating Department Practitioners (ODPs) and asked them the following questions: Are you aware that the colour coding of the drug labels has changed? If you are aware, have you introduced the new (International Colour Coding) system for syringe labelling? If yes, when did you introduce it? Which system is available in your operating theatres? The old labelling system/the new labelling system/or both? Which system are you using now? Do you feel that the anaesthetists and ODPs are comfortable with the new labelling system? Are you aware of any major critical incidents during the change-over period? All the senior ODPs were aware of the International Colour Coding System and 56 out of the 60 had implemented it. Four were still using the ‘Medilabel®’ scheme but were likely to adopt the ‘International’ scheme in the following month or so. None of the departments in the survey had a combination of the two labelling systems in their operating theatres. In 50 out of 60 departments the anaesthetists and ODPs were comfortable using the International Colour Coding. In all the 10 departments where they did not feel comfortable, the ‘International’ scheme had been implemented within the previous 3 months. All the hospitals included in the survey reported initial discomfort of the staff in using the new labelling system in the change-over period, however, none reported a major critical incident related to the change-over. We conclude that the International Colour Coding System for syringe labelling has been widely adopted throughout the United Kingdom. The results are encouraging and may reduce the likelihood of error during drug administration in our anaesthetic practice. However, we would like to emphasise that despite the availability of the International Colour Coding System, errors can still occur and one has to be vigilant when administering a multitude of drugs to a patient.

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