If the experience of residents holds true for their more senior colleagues, then a pilot project at the State University of New York at Stony Brook has the potential to improve syringe labeling in more than one institution. A preprinted label system developed by residents Brian Cho, MD, and Kevin Lee, MD, received an overwhelmingly positive response from study participants, largely due to its convenience and positive effects on efficiency.
“This pilot project started during our first year in anesthesia when we realized that we had to label all our syringes in the OR [operating room],” said Dr. Cho. “We quickly found out that syringe labeling is very important. We do a lot of handoffs in a workday, and having accurate information on our labels is important.
“Nevertheless, it seems we often miss writing down all the information that we need. We will sometimes slap on a sticker for whatever drug is in the syringe and then go do the case. And when we take over a case we often see labels that are inaccurate. So we thought maybe there’s a way to make things better.”
The system developed by Drs. Cho and Lee comprised a standardized template of preprinted syringe labels with the following information: drug name/concentration, user initials and date/time. The labels were created on Microsoft Excel; a macro allowed for quick printing of customized labels for each participating resident. Labels were printed one day before their intended use and were available for pick-up at the OR pharmacy window on the morning of use. Surveys were distributed before and after the four-week pilot to gauge user feedback.
“We wanted to keep the system simple and be able to distribute the labels from a centralized location,” Dr. Lee said. “We ended up using a bin at the central OR pharmacy to distribute the labels when residents went to pick up their meds.”
As reported at the 2014 annual meeting of the International Anesthesia Research Society (abstract S-219), 22 and 15 residents completed the pre- and post-project surveys, respectively. Interestingly, although all respondents indicated the importance of medication syringe labeling for patient safety, only 32% said they always labeled them. The overwhelming majority of residents (85%) preferred the preprinted labels to the existing ones; 78% said the preprinted labels decreased turnover time compared with the existing ones.
Given these results, it is not surprising to learn that all of the residents who participated in the program thought the preprinted labels should be permanent fixtures at the institution.
Dr. Lee added that the system is not limited to use in the OR. “These labels are applicable to other areas where anesthesia is practiced, such as labor and delivery, the electrophysiology lab or even in cardiology.”
Yet as Benedikt Preckel, MD, pointed out, there are bigger concerns with syringe labeling if the system is to become widely adopted. “Since there is an international standard for the labeling of drugs [ISO 26825], I think you should try to follow it in these very early moments,” said the professor of anesthesiology at the Academic Medical Center of Amsterdam, the Netherlands. “Because then you have standardization that can be applied to other hospitals.
“The Netherlands is a very small country, but I recently performed an audit on how we label drugs and found that everybody uses different labels for the same substances,” he added. “I think we could just as easily stick to the ISO standard, which is readily available.”