To Color Code, or Not to Color Code? It Is Now Optional

You are likely familiar with the color coded anesthesia syringes made by many 503b compounding facilities. This color coding system [See Table 1] was originally created by the American Society for Testing and Materials (ASTM). The standard (ASTM Standard D4774 Standard Specification for User Applied Drug Labels in Anesthesiology) was intended for user applied drug labels in anesthesiology to differentiate specific drug classes. As anesthesia providers selected the medication, read the label, and drew up the medication, they would then apply a color-coded label to the syringe. Ideally, anesthesia providers would only require one medication from each class and know what’s in each syringe since they prepared it.

While this standard was not intended for commercially produced syringes, manufacturers eventually began applying it to pre-made syringes in the late 2000s. The inherent problem is that practitioners (pharmacy staff and anesthesia-providers alike) tend to rely more on color, shape, or size of a product than actually reading the label. This can be a major issue when, for example, a practitioner has to select from three different opioids with drastically different potencies that are all the same shade of Blue 297 or three different paralytics that are the same shade of Florescent Red 805.

As of August 17, 2022, ASTM Standard D4774 was officially withdrawn. This may open the door for compounding facilities to better differentiate colors, patterns, and labels across drug classes. On the other hand, front-line practitioners may be engrained in their ways and actually prefer or request this color-coded system when choosing commercially produced syringes. Regardless, relying on color is a weak medication safety strategy, and pharmacists should limit the variety of medications within each class, restrict use of these products to the perioperative setting, and aim to encourage the use of barcode scanning. For more information and recommendations on this topic, please read Color-coded syringes for anesthesia drugs: use with care.

Reference:

Institute for Safe Medication Practices. Color-coded syringes for anesthesia drugs: use with care. ISMP Medication Safety Alert! Acute Care. 2008; 13(25):1-2.