Intended for healthcare professionals

Rapid response to:

Short Cuts

All you need to read in the other general journals

BMJ 2010; 340 doi: (Published 11 May 2010) Cite this as: BMJ 2010;340:c2486

Rapid Response:

Standard colours to label dangerous drugs may improve medication safety.

Serious medication errors are common in hospitals and often occur
during order transcription or administration of medication. The
incorporation of the bar-code verification within an electronic medication
-administration system substantially reduced the rate of errors in order
transcription and in medication administration as well as potential
adverse drug events, although it did not eliminate such errors [1].

As Alison Tonks [2] refers, implementation of this system was hard work
and expensive, at a hospital that already had technologically
sophisticated physician order entry and bar code scanning at the pharmacy.

Results may be different in hospitals without them.
I think that this system sounds very useful in hospital programmed
medication, but beyond expensive, it is time consuming, and may be not
very practicable in emergencies situations, or in institutions with
technical/financial limitations.

To reduce medication errors, it may be useful to implement in addition
other simple measures, like the establishment of international standard
colours to label dangerous drugs (neuromuscular blockers, adrenalin). For
instance: to suture wounds at territories with terminal circulation, we
must use local anaesthetics free of vasoconstrictors to avoid necrosis.
But, the similar labels of local anaesthetic solutions with or without
adrenalin may predispose to serious iatrogenic necrosis of a territory
with terminal circulation, like fingers or penis. Another hazardous
situation may result from the use of a lidocaíne solution with adrenaline
to treat an arrhythmia. In one case I prescribed iv diazepam but gave alcuronium because both drugs were produced by
the same laboratory, and vials/labels were very similar.
Like elevators that have only one engine to climb, but many mechanisms to
avoid its crash, the sequential accumulation of security measures may
reduce medication errors. The approval of international standard colours
to label dangerous drugs also could be useful.


1- Poon E G, Keohane C A, Yoon C S, et al. Effect of Bar-Code Technology
on the Safety of Medication Administration. N Engl J Med 2010;362:1698-

2- Alison Tonks SHORT CUTS All you need to read in the other general
journals BMJ 2010;340:c2486

Competing interests:
None declared

Competing interests: No competing interests

04 June 2010
Fernando Martins do Vale, MD, PhD
Professor of Pharmacology,
Faculty of Medicine-IMM, University of Lisbon . 1649-028 Lisbon