A physician orders the antibacterial drug Unasyn to treat a patient's infection. Unasyn is an injectable combination drug consisting of sulbactam and ampicillin, which is derived from penicillin. The patient, who is allergic to penicillin, has an anaphylactic reaction and ends up in the intensive care unit. A patient almost died because a drug's label contained only the brand name, not its root suffix. Noting both drugs' brand and generic names on containers is just one of a few simple labeling and storage practices that can go a long way toward avoiding such medication errors.

1. Use "tall-man lettering." To distinguish the appearance of product names, use "tall-man lettering" to differentiate the confusing parts of similar-looking medications. For example, write "EPHedrine" and "EpINEPHrine" or "HydrOXYzine" and "HydrALAzine" on labels to make the differences between these similar drugs obvious.

2. Create your own labels. The fonts manufacturers use on their labels can be an issue. A significant challenge we have in the perioperative setting is that a fair portion of the RN population is pushing 50, and many wear (or should wear) bifocals. Grant-ed, we should get over our vanity and keep our glasses on, but your center can create its own labels in a font and type size that make the name and concentration of the product clearly visible to your entire staff. High-quality laser-printed labels are recommended as well, to ensure that labels don't smear.

3. Use both brand and generic names. The size of the information on drug labels isn't all that matters, however. Drugs should be labeled with both their brand and generic names. As illustrated by the Unasyn case, doing so increases the user's understanding of what's being requested, and improves the chances of delivering the correct drug. The inclusion of the drug's generic name provides the user with a visual cue to stop and check against the patient's allergies, to guard against potentially lethal interactions.

4. Bar codes. Bar code medication administration ensures 4 of the "5 rights" of medication safety: the right drug, delivered to the right patient, in the right dose at the right time. It doesn't guarantee the right route of administration. You can still mistakenly give a liquid drug intravenously rather than orally.

5. Forget your ABCs when it comes to storage. We've been taught since grade school to arrange things alphabetically, but storing drugs this way only increases the risk of picking up the wrong bottle or replenishing supplies with the wrong dose. Ampicillin, for example, comes in 125mg, 250mg, 375mg and 1g concentrations. While you may have 4 containers of the same drug, you don't want to have the different strengths next to each other alphabetically. The same concept applies to drugs with similar-sounding names. Don't store Ampicillin and Amoxicillin near to each other. Consult the United States Pharmacopeia's Similar Names List (www.usp.org/hqi/practitionerPrograms/ newsletters/qualityReview/qr792004-04-01.html) for tips on separating look-alike and/or sound-alike drugs, such as physically separating these products, using colored dividers to separate the products on the shelves or applying brightly colored stickers to alert staff to the potential for similarity.

6. Create a reference binder. Catalog drug locations in a binder near the storage area. A binder helps eliminate staff's reliance on memory when reaching for drug containers. Staff can easily get used to grabbing Drug X from the same place every time they reach for it. That's not how we want healthcare providers working. We want them to stop and ensure they're pulling the right drug, as opposed to just grabbing and going.

'Forcing functions'
There are steps that I call "forcing functions" that make you pause before pulling a drug. You can program a cabinet so that staff must enter the patient's allergies before they can retrieve medications. Or, before giving insulin to a diabetic, you can only proceed after entering the patient's glucose level. While proper labeling and storage are obviously essential, adding these steps will do that much more to ensure the right drug is delivered to the right patient at the right time. Consider this: If a police officer stopped you in your neighborhood and told you not to speed anymore, there's no guarantee you wouldn't still do it. But if a speed bump was put in front of your house, it's a pretty sure bet that you'd slow down.