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Int J Ind Ergon. 2011 Jul 1;41(4):394-399.

Improving the usability of intravenous medication labels to support safe medication delivery.

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  • 1Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA, 151 Engineer's Way, PO Box 400747, Charlottesville, VA 22904-4747, United States of America.


Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers' product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital's intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study.

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