The evidence is clear that labeling syringes, medicine cups and basins correlates to improved safety. Those little stickers will help your clinical teams avoid medication errors. Here's a guide to help you make sure that medications are properly labeled in your facility.

Any drawn medication the provider sets down on or off the sterile field should be properly labeled. Syringes require 5 labeling elements: drug, strength, date, time drawn and the initials of the person who prepared the syringe.

Labels are sold with various amounts of information already printed on them. You can get them with drug name and strength pre-printed or just the drug name. Additionally, labels are now available at minimal additional cost with a pre-printed area and space for the provider to add the date, time and initials. Pre-printed labels with blank areas for required information encourage compliance with the medication labeling requirements because empty areas remind the person preparing the syringe or solution of the information that needs to be added.

Besides syringes, other preparations such as intravenous minibags with antibiotics should be similarly labeled. In addition to the drug, strength, date, time drawn and the initials of the person who prepared the bag, I recommend that the preparer add the patient's name to the medication label, as is done in hospitals. For minibags, place IV additive labels on the face of the bag below the manufacturer's label printed on the bag so that the printing on the bag can be read as well.

In eye surgery facilities, prepared solutions such as balanced salt solution with epinephrine should have a label affixed to the container. In the GI suite, solutions of simethicone should be explicitly labeled, whether they're prepared in a pour bottle or a basin.

Beyond-use date labels
Although healthcare facilities should be moving away from using multiple-use vials wherever possible, some medications used in the perioperative setting are still stocked in multi-dose vials, such as succinylcholine, rocuronium, labetalol and insulin. Multiple-dose vials need to be labeled with the "beyond-use date" to accommodate compliance with the "28-day rule," which addresses how long a facility can keep an opened vial before having to discard it. The person who initially breaks the seal should write the date 28 days later, rather than the date when the seal was broken. This will save time for co-workers down the line. If the person writes the date the seal was broken, each person who draws a dose will then need to calculate when the 28-day period ends.

Of course, there are exceptions. Succinylcholine and rocuronium may be stored at room temperature only for specific periods. Succinylcholine can be stored for 14 days and rocuronium can be stored for 60 days unopened and 28 days opened. Thus, labeling on these drugs should address these restrictions. Also, when the manufacturer's expiration date comes before 28 days, consider the earlier date the beyond-use date. Finally, any multiple-use vials used during an emergency in the OR should be discarded regardless of their beyond-use dates because their sterility may have been compromised during the emergency.

Keep it more than clean
Like everything else in the sterile field, medication labels created in the sterile field should be sterile, too. Any syringe drawn in the sterile field should be labeled using a sterile label and a sterile marker. Label manufacturers offer sterile and non-sterile pre-printed labels as well as single-use sterile pens.

Pre-printed labels come with varying amounts of information on them. You'll notice that some companies say that the labels are "custom" if you request strengths pre-printed. Pre-printed strengths on labels is common and you may be able to find them at a lower price from another manufacturer. Shop around before you pay a premium price.

Also check with your anesthesia provider to make sure that strengths printed on the labels are those most often used in your facility. The anesthesia provider should approve the labels based on your current formulary as well as routine dilutions, if any, that they use. Keep a stock of blank labels for physicians who use uncommon strengths.

The person who first opens a vial or who fills the syringes should create and place the label. No one else should do the labeling. Be firm in training staff that no one should ever label something prepared by someone else. ?

Monitoring compliance?
Like hand hygiene, surgical-site marking or instrument reprocessing, medication labeling is a patient safety issue that's on the minds of surveyors and regulatory agencies. Medication errors, the fifth most common sentinel event, are considered preventable "never events" by the National Quality Forum, the Joint Commission and CMS. As a result, CMS, which has embraced the stringent APIC guidelines for safe injection, infusion and medication vial practices, and professional organizations have raised the bar on their expectations for pre-drawn syringes and infusions. AORN says that no unlabeled medication should enter the sterile field. "Label all medications, medication containers, and other solutions off the sterile field even if only one medication is involved," says the organization in its 2006 guidance statement, Safe Medication Practices in Perioperative Practice Settings.

It's not enough to ask your staff to label medications. You must monitor compliance. Observe, unannounced, how and when medications get labeled and who does it. Your compliance can then be benchmarked against other facilities' performance. In the end, the more you pay attention to medication labeling, the more your compliance will improve. As a result, those little sticky things will become powerful tools to ensure patient safety.