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Medilabel Safety SystemŠ

Design to save lives New label design system for medical products

e-Types 2008


Medilabel Safety System© Designed by e-Types/ Jonas Hecksher, Søren Skafte Overgaard, Stina Nordquist, Tobias Grut, Rikke Hagemann, Andreas Peitersen, Pernille Juul Schmidt e-Types Vesterbrogade 80b, 1. sal 1620 København Denmark +45 3325 4500 www.e-types.com info@e-types.com


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Why design New Labels?

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Basic Label Structure

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Variations

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Typeface Medic©

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ATC Colour Code System©

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Strength Colour Code©

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Danger

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Dilution

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9 Design Features

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Three Easy Rules

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Gallery


Preface

American estimates based on anonymous reporting systems indicate that up to 25% of all medication errors are due to confusion related either to the name of the medicine or the packaging design.¹ Medication errors are the most commonly reported treatment errors in the hospital sector. In 2006 almost 5,000 cases of medication errors were reported to the Danish National Board of Health², and 9 % of all patients admitted to hospital in Denmark fall victim to unintentional events or medical errors ³. These unintentional errors equal seven extra days in hospital per patient 4.

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To address this critical issue, The Association of Hospital Pharmacies in Denmark and their purchasing company, Amgros, launched a new label design, which has been in use in Danish hospital dispensaries since 2007.

1/ Institute of Safe Medication Practises, www.ismp.org. 2/ Danish National Board of Health, Annual Report for the Danish Patient Safety Database, www.dpsd.dk. In 2007 the number was above 5000. 3 / Schiøler T et al, Ugeskrift for laeger, sept. 2001 4/ Dansk selskab for patientsikkerhed (Danish Patient Safety Association), Schiøler T et al, Ugeskrift for laeger, sept. 2001.

The design programme has been developed by design agency e-Types. It aims to give health professionals new tools to avoid confusion related either to the name of the medicine or the packaging design. e-Types 2008


Furthermore, a colour code system has been introduced to make products easier to differentiate from other products and a special typeface 'Medic' has been designed to be easy to read even on small labels. 4

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The product name is the most important information on the label. The speciallydesigned typography is easy to read, and this makes correctly decoding the name of the medicine easier. Colours and uppercase letters are used to differentiate between names that look similar.

3. Drug Form, Route of Administration & Quantity The Drug Form/Route of Administration is the third most important information on the label. It is set in a lighter weight that differentiates from and yet visually matches the product name. Quantity is in bold lettering to ensure that it is differentiated from the drug form text.

A

5 mg/ml

Product Name Drug form Route of administration

100 ml

Stored at 2°C – 8°C in original packaging

The label structure ensures that the most important pieces of information like product name and strength are easy to decode. Less important information is printed at right angles to keep a clear focus on the primary information.

1. Product Name

The second most important type of infor- ing. The figures are in large type and there is plenty of space around the strength inmation on the label is product strength. Strength and unit of measurement are po- formation, making it more legible. sitioned identically on all forms of packag-

Vnr 00 00 00

The new label design is a structural framework for a prioritization of the information needed on all medical products.

2. Strength

MTnr. 00000 ATC: A03

Basic label structure

2a. Colour-coded Strength When a product is available in several strengths, colour codes are used to distinguish between different concentrations of the same product, with a corresponding reduction in the risk of under- or overdos-

ing. The strength marker is a colour code ranging from blue over green, yellow and orange, to red. Products that are only available in one strength have a white band at the bottom edge.


4. The ATC Code

0.

Each of the 16 therapeutic subgroup is marked with a band of colour at the top edge of all labels. This ensures that there is clear colour differentiation between the individual specialist hospital departments.

8. Barcode

Opened:

The barcode is further insurance against confusion and is featured on all containers and packaging.

Use by:

Amgros I/S Dampfærgevej 22 · 2100 København Ø

1 ml contains: adrenaline nitrate equals: 1 mg adrenaline 0,5 mg natriummetabisulfit 8,5 mg Natrium Chloride in water for injection fluids Conserved with 0,1% methyl parahydroxybanzoate

All medical products are grouped in accordance with the international ATC system which is already in use to structure storage of medicines in Danish hospital drug dispensaries. Each anatomical main group in the ATC system is marked with a letter (A–V).

5. Declaration of Contents The declaration of contents is, like other pieces of secondary information, printed at right angles to the primary information. In this way the two groups of information are clearly separated and primary focus is

7. Expiry Date Empty space for printing expiry date.

6. Date of Opening on the the most important information. The Medic font makes the declaration of contents easy to read even on the smallest of containers and packages.

Empty space for writing date of opening and, where necessary, time of day.

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Variations

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e-Types 2008


Typeface Medic© e-Types have developed a new typeface, Medic, especially for use on medical labels. Medic is particularly easy to read, even on very small labels. The old design used only ‘Tall Man’ letters: The product names were difficult to read and differentiate from similar product names. See top right illustration. In the new design product names are typed in both lower-case letters and ‘Tall Man’ letters. Lowercase letters give more varied and more legible word-shapes, while ‘Tall Man’ letters help readers to differentiate between products. 8

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The specially designed typeface Medic has several characteristics. The most important feature is “ink drops” which means narrowing the letters at certain points. This stops the type becoming too black and illegible on the smallest labels e.g. on 1 mg ampoules.

Old design

LIDOCAINE

LIDOCAINE ADRENALINE

LIDOCAINE NORADRENALINE

Lidocaine adrenaline

Lidocaine NORadrenaline

New design / typeface Medic

Lidocaine

Ink drops in typeface Medic


The arc is rounded so that it looks better in small font sizes

Improved balance in the stem ensures uniform blackness

Horizontal stroke is shorter than the stem so that they appear to the eye to be equal.

Rounded arc

Rounded arc

The S is opened up - more white in the letter makes it easier to decode in small font size.

Extra flourish "opens up" the G

The figure 5 is redesigned to improve optical impression

The lower ring of the G is narrowed so that the letter is uniformly black.

The arc is rounded

The upward stroke on the M is narrowed

The horizontal stroke is improved optically to improve legibility at small font sizes.

Ink drop is extended so that the letter better maintains its form


ATC Colour Code© One of the most important and innovative features of the new design is the ATC Colour Code© — a visual interpretation of the ATC system, administered by the WHO Collaborating Centre for Drug Statistics in Oslo. The ATC system has been used for classification of drugs sine 1976, but there is no recognised system for interpreting the ATC system in terms of graphics. The new colour code system has great potential as an international standard giving nurses and doctors additional tools to differentiate between products.

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The ATC system is made up of 14 main groups each divided into 16 sub-groups. In the graphic representation each main group is marked with a letter — the system’s first level. Each subgroup is marked with a colour — the system’s second level. Each hospital department will often use medicines within a limited number of main groups. When highlighting the letter codes for the main groups, hospital staff will be able to differentiate the main groups and to easily locate the groups of medicines they normally use.

The new label design introduces using colour at the ATC system’s second level in order to facilitate differentiation between pro­ducts (main groups) often used in specific departments. For example, doctors and nursing staff working at a neurological unit will often use products in main group N.: Medical products — Nervous System.

The ATC Code The ATC Code indicates the product's position within the first and second levels of the ATC system. This information is used, for example, when products are put onto the shelves in the dispensary.

ATC Second Level The ATC system's second level sorts medical preparations into one of 14 main groups and into one of up to 16 subgroups. Each subgroup is assigned a colour of its own that is always used as an accent colour on the labels.

ATC First Level The ATC system's first level sorts all medicinal products into 14 main groups. Each main group has a letter-code. On the labels this letter is highlighted in order to make it easy to identify the main group within which the product is used.

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ATC First Level ď Š

ATC Second Level ď §

A: Drugs for the alimentary tract & metabolism B: Drugs extracted from blood and drugs for blood-forming organs C: Drugs for the cardiovascular system D: Dermatologicals G: Genitourinary system & sex hormones H: Systemic hormonal preparations J: Anti-infectives for systemic use L: Cancer drugs & antineoplastic & immunomodulating agents M: Drugs for the musculo-skeletal system N: Drugs for the nervous system

P: Antiparasitic products R: Drugs for the respiratory system S: Drugs for the sensory organs

V: Various drugs

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03

04

05

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07

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09

10

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A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V

A B C D G H J L M N P R S V


Strength Colour CodeŠ Strength indication on products in the old design was marked only by numbers and letters. Distinguishing between different strengths was difficult, and the risk of administering the wrong medicine was high.

A coloured band at the bottom of the label supplements the printed strength indication in the top left corner. Blue represents the weakest strength, middle strength is yellow and the strongest strength is red. When indication of 5 different strengths of the same product is needed, orange and green are added as middle steps.

In the new design, a Strength Colour Code is used to mark whether a given medicine is weak or strong in comparison to other strengths of the Medical preparations, same medical preparation. available in one strength only, have a white band inThe colour system is instead of a coloured. In this spired by a coloured map way there will never be showing temperatures any doubt as to whether across the globe changing a particular product is from cold blue areas to available in a different warm red areas. A colour strength. scale familiar to most. 12

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When a product is available in one strength only, there is no strength colour code.

When a product is available in two strengths, the weaker strength is blue and the stronger one red.

When a product is available in three strengths, stripes of blue and red are used, plus middle strength yellow.

When a product is available in four strengths, blue, green, orange and red are used.

When a product is available in five strengths, all five colours are used, i.e. blue to red.

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Read first The strength of any medicine is always printed at the upper left-hand corner of the label in a font size that clearly differentiates it from other less important types of information. Bearing in mind that the

Coloured band reading direction starts in the upper left-hand corner, it is difficult to avoid reading the strength, even though the medicine name takes up more space and has a more prominent position.

The Strength Colour Code always appears as a band of colour at the bottom edge of the label. This indication is indispensable where several ampules of the same product in different strengths are

placed side by side. In such cases, it is important that it is easy to differentiate between an ampule with a strong concentration of the product from an ampule with a weaker concentration.


Dangerous Drugs It is crucial that particularly dangerous drugs are marked with a warning signal. In the old labelling system used in Danish hospitals, Calium Chloride was marked with a large 'K' in red raster. In the wake of a fatal case of confusion between two drugs, the red of the letter K has been further intensified. The weakness of the old system was that warnings were not implemented on all surfaces – e.g. it was not marked on package ends. Another problem would arise if the K was used alongside the ATC system’s many colours. 14

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In the new system, highly dangerous drugs have fluorescent yellow labels. The yellow is used on products where a single dose would have fatal consequences. The yellow colour warns staff to take extra care and read the label carefully.


Dilution Some medicines are highly concentrated and need dilution before they can be administered to patients. A clear indication of dilution is crucial to avoid fatal doses.

The diagonal stripes give a clear and familiar signal that extra care is needed. In addition the text ‘must be diluted� is printed above the product name.

The marker for dilution must be different from the yellow danger marker. At the same time, the dilution marker must work alongside the danger marker. The new dilution marker is a layer of diagonal white stripes, which is printed over the ATC and strength coloured bands.

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Dilution Markers The diagonal stripes cover the coloured bands at the top and the bottom of the label. In cases where there is no strength coloured band at the bottom, only the top band has diagonal stripes.

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Summary / 9 Innovative Features

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e-Types 2008


1

Format

Labels should be as large as possible to ensure legibility and to create clear differentiation between the different types of information required. The information is, in effect, pre-sorted and the new design provides a framework for the different types of information.

2

3

Typeface Medic©

Words in only tallman letters are difficult to decode, as all letters are of the same height. The new label design features a specially designed typeface and uses lower-case lettering while tallman lettering is used only for differentiating between similar products.

ATC Colour Code©

One of the most innovative features of the new design is the ATC Colour Code© – a visual interpretation of the ATC system (Anatomical Therapeutic Chemical Classification System). The colour code system helps nurses and doctors choose the correct product.

LidocaineLidocaine NORadrenaline NORadrenaline

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5

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Dangerous drugs

Dilution

Particularly dangerous drugs which need handling with extra care have a fully-coloured, fluorescent yellow label.

Products that must be diluted are marked with diagonal warning stripes.

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Lidocaine NORadrenaline

AFRIVES HER

Lidokain-

Lidocaine adrenalin SAD NORadrenaline

Strength Colour Code©

Strength is printed in the upper left-hand corner of the label in a comparably large font size. Products available in several strengths are differentiated by means the Strength Colour Code.

Special Instructions

Additional information about medicinal products that require special attention or handling is specially marked on the labels.

Packaging

Labels on more sides of packages increase safety.

• Iron preparation

For infusion fluids, further differentiation can be achieved by using colour coding, and, in some cases, labels with watermarks. In certain cases, a label with a tinted background colour can be used on ampules.

Gradient and Watermark

Tinted background colour

TEAR HERE

• Epidural

Further differentiation

55 mg/ml

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e-Types 2008


Three Easy Rules for busy hospital staff

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Dangerous

Particularly dangerous drugs are marked with a yellow label. The yellow colour is a warning and a reminder for users to take extra care: Read the label one more time.

Dilution

Drugs which must be diluted are marked with diagonal white stripes and the text "dilute before use".

Strength

Medicines available in several strengths are marked with a band of colour at the bottom edge on packages and bottles or left side of the label on ampoules. Colours go from blue to red, where blue is the weakest concentration and red the strongest. Medicines, available in one strength only, have a white band at the bottom of the label.


More Variations

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e-Types 2008



Medilabel Safety System