British syringe label ‘standards’ are an accident waiting to happen

We agree with Dr Radhakrishna that a consistent colour standard is required for user-applied syringe labels (Anaesthesia 1999; 54: 963–8). Colour is a powerful psychological cue [1–3], which can facilitate the identification of drugs. Some have argued that the use of colour reduces the likelihood that the label will be read. It should be emphasised that colour used correctly is a supplement to, rather than a substitute for, this important task. If colour coding is applied by class of drug, the label must still be read in order to identify the specific drug within the class. The use of more than one type of cognitive cue (colour and text) provides multiple opportunities to trap potential errors before they occur. Such an approach is consistent with the safety principles of complex-systems theory developed in the nuclear and aviation industries – an approach which anaesthesia is increasingly adopting in an effort to avoid anaesthetic error and iatrogenic harm [4–7]. However, if colour is to be used, a consistent colour standard for drugs is very important. The situation described by Radhakrishna in Britain, with contradictory label systems used in different hospitals and even within the same hospital, is clearly an accident waiting to happen. Faults like these in organisations are called latent errors and we know from an extensive literature in other fields that their existence guarantees that it will only be a matter of time until errors are made because of them [2–8]. In fact, it is very likely that such errors have already happened. As Radhakrishna states, consistent colour-code standards already exist in Australia, New Zealand and the USA [9, 10], and all of these use the same set of colours for drug classes. An identical colour standard also exists in Canada [11]. However, it seems that the colours used in Britain differ from the colour standards used in these countries. This creates a further problem for overseas anaesthetists coming to work in Britain and for British anaesthetists working overseas. Radhakrishna suggests that it may take sometime before a consistent colour standard can be adopted in Britain and that in the interim British anaesthetists should stop using colour as a cue in syringe identification. This seems counter-productive, however, as the use of colour is currently widespread in Britain and can be a valuable aid to safety. The simplest solution would be for Britain to adopt the colour standard used in the above mentioned countries. The transition involved in the adoption of any internationally consistent standard may carry logistical difficulties and some risk. With respect to user-applied syringe labels, however, the safety benefits would be considerable while the risk is likely to be no more than continuing with the status quo. We suggest that the best approach would be for anaesthetists to move to a consistent British standard as soon as possible.

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