LAUSR

INTRODUCTION Practice variability is associated with human error and adverse drug events. We sought to describe the practice variability that exists with drug labelling among a cohort of anaesthesia residents in an academic medical centre. MATERIAL AND METHODS In a controlled, lecture-style environment, residents were instructed to prepare a syringe of atracurium. Label location (longitudinal vs. circumferential), orientation (right hand vs. left hand), compliance, and legibility were assessed. RESULTS A total of 32 syringes with 48 labels were analysed, of which 11 (34%) had a single longitudinally placed label, 6 (19%) had a single circumferential label, and 15 (47%) had both longitudinally and circumferentially placed labels. Of syringes with longitudinally placed labels, 17 (63%) were placed in the right-hand orientation, 9 (33%) in the left-hand orientation, and 1 (4%) had 2 labels placed in both orientations. Of the syringes with circumferentially placed labels, 17 (81%) were placed in the right-hand orientation and 4 (19%) in the left-hand orientation. Overall compliance with longitudinal and circumferential labels was 95.6% and 43.8%, respectively. Overall legibility with longitudinal and circumferential labels was 90.7% and 90.5%, respectively. CONCLUSIONS A great deal of practice variability with syringe labelling among anaesthesia residents was observed, with significant non-compliance of circumferentially placed labels, which could play a role in increasing the risk of drug errors.