title: Use of a new task-relevant test to assess the effects of shift work and drug labelling formats on anesthesia trainees' drug recognition and confirmation.
abstract: BACKGROUND
  Drug administration errors occur in every aspect of clinical practice. Using a novel task-relevant Medication Recognition and Confirmation Test (MRCT), we investigated the effects on performance of working night and day shifts and labelling different drug formats.
  
  
  METHODS
  Anesthesia trainees (n = 18) participated in one of two experiments during an 8-12 hr day shift and an 8-12 hr night shift. In Experiment-1 (n = 10), we compared standardized colour-coded labels with pictures of ampoules. In Experiment-2 (n = 8), we compared colour-coded labels with black and white labels. Sleep was measured with wrist actigraphy during both day and night shift runs over seven to eight days. The MRCT outcome measures were reaction times and drug errors.
  
  
  RESULTS
  In the two experiments, colour-coded labels were recognized (and therefore selected) more quickly than pictures of conventional ampoules (mean difference 332 msec, 95% confidence interval (CI) 242-422 msec; P < 0.0001) and faster than black and white labels (mean difference 96 msec, 95% CI 46-146 msec; P < 0.0001). Participants obtained less sleep while working night shifts than while working day shifts (mean difference 57 min, 95% CI 0:15-1:39 hr; P = 0.013). Mean confirmation reaction times were slower during night shifts than during day shifts (mean difference 60 msec, 95% CI 1-120 msec; P = 0.048). No differences in error rates were observed between shifts or among drug label types.
  
  
  CONCLUSIONS
  Label format influenced recognition and confirmation reaction times to representations of drugs in this study, and we found some evidence to suggest that performance is better during day shifts than during night shifts. The task-relevant test evaluated here may have further application in measuring performance in the wider clinical setting.
authors.affiliation: Department of Anaesthesiology, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, New Zealand.
authors.forename: James F
authors.initials: JF
authors.lastname: Cheeseman
authors.forename: Craig S
authors.initials: CS
authors.lastname: Webster
authors.forename: Matt D M
authors.initials: MD
authors.lastname: Pawley
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Francis
authors.forename: Guy R
authors.initials: GR
authors.lastname: Warman
authors.forename: Alan F
authors.initials: AF
authors.lastname: Merry
mesh_terms: D056044:Actigraphy; D000328:Adult; D000758:Anesthesia / Q000379:methods / Q000592:standards; D000776:Anesthesiology / Q000193:education / Q000379:methods*; D003116:Color; D004348:Drug Labeling / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010561:Personnel Staffing and Scheduling; D011930:Reaction Time; D012890:Sleep; D014940:Work Schedule Tolerance