Sunday, June 16, 2013

Drug Labels Shouldn't Be This Confusing

Our hospital, like most hospitals, shops around for the cheapest vendors for our necessities. That's why generic supplies, everything from oxygen masks to anesthesia circuits to generic drugs, can change from month to month. Most of the time there is little difference in products between the companies, such as endotracheal tubes that are essentially identical yet can save the hospital a few pennies by going to a different vendor.

A couple of weeks ago, the vascular surgeon asked for 5,000 units of heparin to be given to my patient on the O.R. table. I immediately reached for the heparin section of the anesthesia cart. It felt different from the heparin we were using before. It appeared like we had found another vendor to supply our heparin now. When I grabbed the bottle, I stopped and took a second look at the label. Yes it was clearly marked "heparin". But what caught my eyes was the dosage in bold number under the name. At first the only thing I saw was "10,000". Holy crap, did somebody stock my cart with the 10,000 units/mL concentration of heparin? This is not a minor issue as heparin comes in different concentrations. Many doctors here know of the unfortunate incident a few years ago when a Hollywood celebrity's newborn children were accidentally given a massive overdose of heparin in a local hospital because the wrong concentration was supplied in the nurses' drug cart and nobody bothered to read the label when it was given to the patients.

Staying calm, I kept focusing on the drug label. Sure enough, in small lettering under the "10,000" was the actual concentration of heparin inside, 1,000 units/mL. The 10,000 units referred to the entire contents of the bottle, which was 10 mL. But you had to rotate the bottle slightly to get to the part about the 10 mL that was contained within. Assured, I gave the patient his 5,000 units of heparin.

I don't understand why this drug company, ahem Hospira, would put at the top of its label the entire quantity of drug within the bottle. That is not how we work. It's comparable to buying a car advertised as getting 600 miles per tank of gas when what we want to know is it gets 30 miles per gallon. We don't need to know that there are 10,000 units of heparin inside the bottle. We always calculate how much drugs to give based on its concentration per mL.

For instance, these labels on the propofol and atropine bottles got it right. Immediately under the names of the drugs, in large lettering, are the concentrations of the drugs in mg/mL. I don't need to know that there are 8 mg of atropine in the bottle. I'm unlikely to give an entire bottle of atropine to the patient. I just need to know how much is in each mL I inject.

To any drug company presidents out there that may be reading this. Please take a close look at the labels you put on your products. Even though all of us should double check the information before we give it to the patient, it would really help us out if we could get the vital facts as quickly and accurately as possible. We have enough trouble as it is differentiating the myriad of drugs in our carts. Any assistance that can be given to improve patient safety would be greatly appreciated.

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