National Standard for User Applied Labelling of Injectable Medicines Fluids and Lines - No Longer Applicable - Superseded by MP 0131/20 - 10 February 2020

Applicable to: WA Public Hospitals

Description: The Australian Commission on Safety and Quality in Healthcare has released the National Standard for User-applied Labelling of Injectable Medicines, Fluids and Lines (the Labelling Standard) in September 2015.

National Standard for User-Applied Labelling of Injectable Medicines, Fluids and Lines

AMENDMENT TO OD0647/16: Change to compliance date.

Hospitals are required to comply with the National Standard for User-Applied Labelling of Injectable Medicines, Fluids and Lines (including the WA modification identified in this Operational Directive) by October 31, 2016.

The Australian Commission on Safety and Quality in Healthcare has released the National Standard for User-applied Labelling of Injectable Medicines, Fluids and Lines (the Labelling Standard) in September 2015.

The Labelling Standard expands on the Labelling Recommendations (OD 0385/12) to include:

  • Labelling of containers in perioperative settings (including cardiac catheter and interventional radiology units) 
  • Colour-coded preprinted medicine labels for use on dedicated continuous infusion lines 
  • Liquid medicines for oral, enteral and inhalational use 
  • Labelling of non-injectable medicines and fluids prepared in the same area as injectable medicines. 
WA modification to the label stippling of beige, blue and red labels addresses an identified safety issue with readability, and as such this modification remains a part of the WA Operational Directive.

Hospitals are required to comply with the Labelling Standard (including the WA modification identified in this Operational Directive) by March 31, 2016. 

BACKGROUND

Labelling is a recognised risk in the safe administration of injectable medicines. Preparation of injectable medicines for bolus injection or infusion is complicated with multiple opportunities for error. Labelling of injectable medicines is often not done or incomplete, omitting information such as name of medicine, dose, patient name or time of preparation1.

It has been shown that errors in injectable medicine administration are less likely to occur when a single person is responsible for preparing and labelling each injectable medicine, and that medicines in well labelled syringes are more likely to have been prepared correctly1. 

THE LABELLING STANDARD

This National Standard for User-applied Labelling of Injectable Medicines, Fluids and Lines (the Labelling Standard) has been developed as a national solution to the risks posed by erroneous administration of injectable medicines. It replaces the 2012 National Recommendations for User-applied Labelling of Injectable Medicines, Fluids and Lines (the Labelling Recommendations) which were developed by the ACSQHC  to (a) assist health care professionals to identify the correct medicine and/or fluid and its correct administration route/conduit at all times, and (b) set out requirements for label inclusions and label placement. 

Adherence to the Labelling Standard will minimise preventable medication administration errors (such as wrong route, wrong medicine, wrong dose and wrong patient) and improve safe medicine use. 

Minimum Requirements:

The Labelling Standard is based on the following practice principles: 

  • All medicines and fluids removed from the manufacturer’s or hospital pharmacy’s original packaging must be identifiable.  
  • All containers (e.g. bags, syringes) containing medicines leaving the hands of the person preparing the medicine must be labelled.  
  • Only one medicine should be prepared at a time and labelled before the preparation and labelling of a subsequent medicine. 
  • Any medicine or fluid that cannot be identified (e.g. in an unlabelled syringe or other container) is considered unsafe and should be discarded. 

ACCESSING THE LABELLING STANDARD

The Labelling Standard is attached and can be accessed at:

IMPLEMENTATION RESOURCES

A range of support materials, resources and tools to assist in implementation of the Labelling Standard have been developed, including:

Powerpoint education:

http://ww2.health.wa.gov.au/~/media/Files/Corporate/general%20documents/Quality/Powerpoint/2015%20WA%20User-Applied%20Labelling%20of%20Injectable%20Medicines%20Fluids%20and%20Lines%20Education-PowerPointPresentation.ashx
  • Label specifications for specialist clinical areas (Perioperative, interventional cardiology and radiology, and intensive care units): 
   http://www.safetyandquality.gov.au/our-work/medication-safety/safer-naming-labelling-and-packaging-of-medicines/user-applied-labelling/specialist-clinical-areas/
  • A series of posters:
http://www.safetyandquality.gov.au/our-work/medication-safety/safer-naming-labelling-and-packaging-of-medicines/user-applied-labelling/support-materials/

http://www.safetyandquality.gov.au/wp-content/uploads/2012/02/Perioperative-area-A4-poster-Dec-12-Press.pdf

http://www.safetyandquality.gov.au/wp-content/uploads/2014/02/Line-label-guide-A4-MAY14.pdf

PRINTING SPECIFICATIONS

The recommended labels can be accessed in EPS (for professional printing) format here:

http://www.safetyandquality.gov.au/our-work/medication-safety/safer-naming-labelling-and-packaging-of-medicines/user-applied-labelling/labels/

WA health services and hospitals must follow these specifications, including WA modifications identified below, and advise their printing services accordingly.

WESTERN AUSTRALIAN MODIFICATION TO THE LABELLING STANDARD

Stippling to Beige, Blue and Red Labels

The Labelling Standard specifies a 70% stipple (70% shade of the labels primary colour) to the background of container, conduit and line labels.

Following feedback regarding the legibility of written information on certain coloured labels,  beige (subcutaneous), red (intra-arterial) and blue (intravenous) container, conduit and line labels used in Western Australia will employ a stipple of  50%  to the background area (the area inside the border) of the label. Border colours must not be altered from those specified in the Labelling Standard.

AUDIT AND EVALUATION

It is highly recommended that compliance with the Labelling Standard be audited, including pre- and post-implementation audits. To assist health services and clinical teams the following resources are attached:

  • Sample audit tools. Sites are encouraged to adapt the tool to suit their local requirements.
  • Suggested content for a staff survey on adherence to labelling protocols, and awareness, implementation and adherence to the Labelling Standard. This survey can be carried out using tools such as Survey Monkey (www.surveymonkey.com).

ISSUES REGISTER 

The Quality Improvement and Change Management Unit will maintain an issues register regarding the Labelling Standard.

These may be notified via email: qicm@health.wa.gov.au

Attachment:
  • Australian Commission on Safety and Quality in Health Care National Standard for User-applied Labelling of Injectable Medicines, Fluids and Lines.


Dr David Russell-Weisz

DIRECTOR GENERAL
DEPARTMENT OF HEALTH WA

Date of effect: 01 January 2016 to 10 February 2020

Policy Framework

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