eyeTech Talk: Color-Coded Caps- Yea or Nay?

Technician Talk Color-Coded Caps: Help or Hindrance?

In 1996 the Academy of Ophthalmology (AAO) published a Policy Statement endorsing the uniform use of a color-coding system for the caps and labels of topical ocular medications with an objective to help patients distinguish between various medications, thereby minimizing the risk of patients selecting the incorrect one. The system was later approved by the FDA and manufacturers on a voluntary basis.  The color scheme is listed below:

Tan= Anti-Infectives

Pink= Anti-Inflammatory (Steroids)

Red=Dilation (Mydriatics & Cycloplegics)

Gray= Non-steroidal Anti-inflammatory (NSAIDS)

Dark Green= Miotics

Yellow= Beta Blockers

Dark Blue- Beta Blocker Combinations

Purple= Adrenergic Agonists

Orange= Carbonic Anhydrase Inhibitors

Turquoise= Prostaglandin Analogues

This seemed like a great idea to this ophthalmic technician, as it made my job easier when the doctor asked for a particular type of eye drop.  Color-coded lids also made it easy to identify an eyedrop when the patient was not sure what they were using.  All I had to do was ask the color of the lid and the doctor would at least know the therapeutic class of the medication.

In January 2010, The American Association of Eye and Ear Hospitals (AAEEH) asked for a review of existing patient safety literature and medication error reports that pertain to LASA (look alike sound alike) drugs. As a part of this initiative, AAEEH is “strongly recommends that the FDA and pharmaceutical manufactures of ophthalmic solutions and suspensions consider abandoning the color-coding system that was implemented in 1996…” http://www.nyee.edu/pdf/lasa-aaeece-letter-to-fda.pdf

The American Academy of Ophthalmology Board of Trustees reaffirmed and approved their original Policy Statement in May 2010.  http://www.aao.org/about/policy/upload/color-codes-for-topical-ocular-medications-2010.pdf

In May 2011, the American Glaucoma Society published their Position Statement that included, “We strongly advocate for maintenance, strengthening, and regulatory enforcement of the cap color-coding requirements currently in place.” http://www.americanglaucomasociety.net/patients/position_statements/color_coded_caps_for_glaucoma_drops

Color me curious as to what will happen to our crayon-colored caps.   What are your thoughts-keep the same system, or make a change?

Submitted by guest blogger Rebecca Johnson who owns EyeTrain4You (CPOT), Ophthalmic Technician (COT), and Ophthalmic Executive (COE). She has presented over 300 education and motivational courses at ophthalmic meetings across the nation, published numerous industry articles and is the Editor of the Self Study Course for Paraoptometric Certification, Third Edition. She currently holds a position as Trustee on the American Optometric Association Paraoptometric Council.  Rebecca is the recipient of the 2007 American Optometric Association Paraoptometric Special Service Award and was honored as Vision Monday’s “Most Influential Women in Optical” in 2010.

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Comments

  1. March 28, 2012

    Dear Ms. Johnson CPOT:

    Thank you for quoting our AAEECE Worldwide Patient Safety Initiative to Address LASA Eye and Ear Related Medication Errors Letter to the FDA in your March 15, 2012 online article titled “eyeTech Talk: Color-Coded Caps – Yea or Nay?” http://theopticalvisionsite.com/education-and-events/easy-eyetech-talk-color-coded-caps-yea-or-nay/ which stated “As a part of this initiative, AAEEH “strongly recommends that the FDA and pharmaceutical manufactures of ophthalmic solutions and suspensions consider abandoning the color-coding system that was implemented in 1996…” http://www.nyee.edu/pdf/lasa-aaeece-letter-to-fda.pdf . We would like to take this opportunity to clarify with you the actual goals of our association’s Worldwide Patient Safety Initiative as well as to review what has been accomplished since its launch in January of 2010. The American Association of Eye and Ear Centers of Excellence (AAEECE), formerly the AAEEH, is comprised of the world’s premier centers for specialized eye and ear procedures. Eye and ear specialty hospitals have led the way as providers of high-quality, cost-effective outpatient health care services. The mission of these specialty institutions requires that they maintain leading edge technologies, enabling them to provide highly specialized services not available in general hospitals.

    On January 11, 2011 the AAECEE send a letter to the FDA Commissioner, the Honorable Margaret Hamburg, introducing the Patient Safety Initiative and “asking the FDA for assistance with an issue that continues to threaten patient safety. The issue relates to look-alike sound-alike (LASA) ophthalmic medication errors”. We wrote:

    “Medication errors due to LASA drugs are unfortunately common in the United States and are responsible for thousands of injuries, deaths, and millions of dollars in cost each year. Up to 25% of all medication errors are attributed to product name confusion, while 33% have been attributed to packaging and or labeling confusion. According to the MEDMARX Data Report published by the United States Pharmacopoeia (USP) in 2008, 26,000 records were reviewed and a list of 3,170 look-alike sound-alike drug names were identified that may have contributed to healthcare practitioner related medication errors. …. In an effort to directly address these medication safety issues that affect our hospitals, physicians, nurses, pharmacists, and patients on a daily basis, the AAEECE strongly recommends that the FDA and pharmaceutical manufactures of ophthalmic solutions and suspensions consider abandoning the color coded system that was implemented in 1996, ensuring that all ophthalmic drugs are provided in clearly labeled containers that are easily distinguishable in the clinical practice setting as well as in the homes of our patients. We will invite the American Academy of Ophthalmology to join us in working together with the pharmaceutical companies, nationally and internationally, to address and correct this ongoing patient safety issue. Packaging and drug labeling must differ based on the volumes of the medications to further distinguish one product from the other (an example of such a problem is seen with pilocarpine 15ml from Falcon where the 1% bottle and the 4% bottle look identical).

    In addition we would like to advocate new patient safety strategies that have already been successfully implemented in hospitals throughout the United States. These include the use of tall men lettering systems on product labels to minimize LASA reading errors (ex. Tobrex® and Tobradex®). We ask the FDA to work with manufacturers to be more sensitive to the visual limitations of their patients who are at the greater risk for selecting an incorrect ophthalmic solution, especially when multiple eye drops have been prescribed by their physicians for treatment. Manufacturers must be urged to review existing policies and practices of packaging drugs which include a review of color schemes, fonts, plastic wrapping designs and logo placement on external boxes as well as on the actual bottle which holds the medications. We also ask that the pharmaceutical manufacturers take these concerns seriously and adopt new and innovative safety practices when naming and manufacturing new ophthalmic solutions and containers (ex. Cosopt® and Azopt®). Risk assessments programs should also be performed prior to the marketing of new drugs, which take “front line” healthcare feedback, including risks associated with the administration, storing, and distribution of potential LASA meds, into consideration.”

    In a follow-up January 2010 letter to the FDA we clarified the statement by stating that the “LASA issue” was not limited to the exclusive elimination of the AAO color coding system, but instead a part of larger contributing factors issues, including drug manufacturer-related labeling and packaging systems,” To restate the AAEECE is not calling for the elimination of the AAO color code cap system for ophthalmic products. To the contrary, it is our position that this system, like others, must be built upon by conducting research that would (review) and identify additional methodologies which will reduce the patient safety issue of LASA packaging for ophthalmic products. We have been in communication with the AAO and AGS in the spirit of collaboration of working towards reducing these errors that affect our patients, pharmacists, nurses, and physicians alike.”

    In addition, since February of 2010, we have sent out the following position statement as part of the Worldwide Patient Safety Initiative’s informational mailings to our supporting national and international healthcare organization which include:

    “AAEECE Worldwide Patient Safety Initiative (supported by ISMP and ASORN) to Address LASA Eye and Ear Related Medication Errors”

    “In an effort to directly address these medication safety issues that affect our hospitals, physicians, nurses, pharmacists, and patients on a daily basis, The American Association of Eye and Ear Centers of Excellence (AAEECE), formerly The American Association of Eye and Ear Hospitals (AAEEH), are asking for the American Academy of Ophthalmologists and other domestic and international organizations to support and partner with us to review existing patient safety literature and medication error reports that pertain to these products and to promote new research to identify best systems and safety improvements that will benefit both patients and healthcare professionals with/without visual impairment. We urge manufacturers to work with us in revising existing policies and practices of packaging these drugs which include a review of color coding, color schemes, fonts, plastic wrapping designs and logo placement on external boxes as well as on the immediate drug container. We also ask that the pharmaceutical manufacturers adopt new and innovative safety practices when naming and manufacturing new ophthalmic solutions and containers (ex. Cosopt and Azopt). Finally, we urge that they also conduct risk assessments programs, prior to the marketing of new drugs that include patients with visual impairment and “front line” healthcare professional for feedback which includes a review of the administration, dispensing, storing, and distribution of potential LASA medications.”

    I hope this letter makes it clearer to you what the actual goals of the AAECE Worldwide Patient Safety Initiative to Address LASA Eye and Ear Medication Errors truly are. We invite you to read our mission statement on our website at http://www.nyee.edu/lasa-e-petition-mission.html. You can also read more about our accomplishments and projects on our E-petition News site located on http://www.nyee.edu/lasa-e-petition-updates.html. Lastly we invite you and your colleagues to assist us by completing a short 8 question (3 minute) survey at http://www.surveymonkey.com/s/7FVF5T7 which will allow us collect anonymous outcome data about LASA eye and ear medication errors with the pharmaceutical manufacturers of ophthalmic and otic products and the United States Food and Drug Administration (FDA) so we can review these LASA errors that have occurred worldwide in different healthcare settings and in patient homes.

    Thank you.

    Robert Betz, PhD
    President
    American Association of Eye and Ear Centers of Excellence (AAEECE)
    1655 North Fort Myer Drive Suite 700
    Arlington, VA 22209 USA
    703-243-8848 – Tel
    703-351-5298 – Fax
    http://www.aaeece.org

  2. Dr. Betz,

    Thank you for taking time to clarify the goals of the AAEECE, allowing our readers an opportunity to learn more about the steps that your association is taking to provide a greater degree of patient safety. Your post brought out several great points regarding the “look alike sound alike (LASA)” medications that are prescribed to patients who sometimes have quite diminished vision.

    I encourage our readers to review the links that you provided and participate in your survey.

    Rebecca Johnson

  3. I would like to hear from our readers stories that relate to this article. Have you had patients who have used the wrong medication due to it looking like another medication?

  4. I have definitely picked up the wrong bottle, not even thinking. It is confusing, with so many long names, generic names.. so many diseases.

  5. One thing that scares me is how much nail glue looks like an eye drop bottle!

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