Optimization of morphine ampoules for injection

Confusion between two drugs or dosages is a major risk in the hospital. One major cause of confusion is similarity between ampoules. Beside this aspect, the cost/quality ratio has to be considered for economical reasons. Thus, efforts should be made by producers to provide ampoules with a perfect and easily recognizable identification at the lowest price. Wishing to increase safety of our medication use system, we asked a team of 23 different users (doctors, pharmacists and nurses) to compare four different systems of identifying and labelling ampoules containing injectable morphine, a drug typically used in almost all wards, and especially in anaesthetics, emergency medicine and intensive care. Two of the examined ampoules were from the same producer, DENOLIN, who wished to test a new prototype (DN) beside his ampoule currently available (DO). The two other morphine ampoules available on the Belgian market were from two other producers, STEROP (ST) and STELLA (SE), respectively. The 10, 20, 30 and 40-mg dosages were examined when available. Twenty-one subjective criteria were evaluated using a five-point Likert scale (from 1 = unsatisfying to 5 = excellent): five criteria concerned global packaging, nine evaluated unit-dose packaging and seven scored the ampoule itself. No criteria concerned the content supposed equivalent for all producers. Each participant provided an individual evaluation for all criteria and all drugs. Data were analysed by ANOVA with Newman-Keuls post-hoc tests (P < 0.05). For the DN, DO, ST and SE products, global quality was rated 3.99, 3.61, 2.30 and 2.20, respectively. External packaging scored 3.55, 3.49, 2.82 and 2.61. Similarly, unit-dose packaging was 4.27, 4.00, 1.89 and 1.99 while ampoule was rated 3.94, 3.20, 2.48 and 2.19. Quality/cost ratios were 4.2, 3.1, 2.1 and 1.8, respectively. The DN prototype was thus the first-choice product, as confirmed by statistical tests. Suggestions were made to still improve its quality and safety.