Patent Publication Number: US-2009226378-A1

Title: Coded medications and methods of preparing same for identification and distinguishment

Description:
This application is a continuation-in-part of prior application Ser. No. 12/322,021, filed Jan. 28, 2009, which claims the benefit of U.S. Provisional Application No. 61/062,650, filed Jan. 28, 2008, both of which are incorporated herein by reference thereto. 
    
    
     BACKGROUND OF THE INVENTION 
     This invention relates to coded medications and methods of preparing same for identification and distinguishment. More particularly, this invention relates to identifiable coded injectable fluid medications, and to methods of preparing same, and to different coded injectable fluid medications to distinguish such medications, one from the other, and to methods of preparing same, for use in the treatment of patients, and to reduce and eliminate medication-selection errors, which have occurred in the past, and which could be potentially traumatic to patients, to whom the erroneously selected medications are to be administered. 
     Medication errors remain a significant threat to human health. There are currently many different organizations that monitor medications and associated errors resulting in significant patient morbidity and mortality. The Food and Drug Administration of the U.S. Department of Health and Human Services (“FDA”) has campaigned to reduce and eliminate medication errors. This reduction in medication errors has been addressed in the handling and administration of medications, which included inappropriate labeling and abbreviations. Drug mix-ups of similar appearing medications have resulted in death. For example, as noted in The FDA Patient Safety News, June 2007, a clear liquid diuretic and a clear liquid cardiovascular medication had similar vial labels and caps, which lead to an incorrect selection of medication, resulting in cardiac arrhythmia in the patient following the administering of the incorrectly selected medication. The majority of injectable medications are clear, and are not distinguishable after the medication is drawn into a syringe or a bag of clear intravenous fluid. 
     The Joint Commission International Center for Patient Safety has extensively addressed medication errors. Strategies to reduce medication errors are multi-factorial, which includes handling, human error, mislabeling and misreading of handwriting and abbreviations. According to a report released by the Institute of Medicine, “between 44,000 and 98,000 deaths may result may result each year from medical errors in hospitals alone. And more than 7,000 deaths each year are related to medications.” Again the magnitude of this issue has resulted in recent FDA proposals for bar codes on drugs and user-friendly format labeling for physicians to reduce errors and subsequent adverse effects, including death. 
     Oral medications have some identification, such as, for example, color, shape, wording, and numbering. However, injectable medications, with few exceptions, are all clear when provided in a vial, or other form of container, which may have an identification label. However, once a clear injectable medication is removed from its identifying vial or container, the medication looks no different than other clear medications, whether in an unlabelled vial, a syringe or an intravenous fluid bag. 
     The only way, heretofore, to identify the clear medication is to label, in some way, its container such as, for example a vial, a syringe and an intravenous fluid bag, which, as we know, has lead to medication error, be it from mental distraction by the medical provider, mislabeling, etc. The main areas of focus for unmistakable identification of clear injectable medications include operating rooms, emergency rooms, coronary care units, and intensive care units, where potent respiratory and cardiac medications are used. In addition, such errors can occur in facilities, such as hospital and public pharmacies, from which pharmaceuticals are ultimately supplied at the direction of a physician. 
     Injectable medication mistakes from improper labeling have resulted in cardiac and respiratory arrest in all of the above-cited areas due to overdosing of narcotics, electrolytes, such as potassium, and benzodiazepine overdose to cite a few examples. Myocardial infarction, hypertensive crisis and fatal arrhythmias have also occurred from mistaken administration of cardiac stimulants and vasopressors such as epinephrine, phenylephrine and ephedrine. 
     In addition, the operating room, with related anesthesia events, provides an additional and unique arena for clear injectable medication error, where busy and overworked anesthetists and anesthesiologists inject potent respiratory and cardiovascular medications many times daily. Many times, the hurried provider withdraws a clear medication from a labeled vial, but does not label a syringe, or draws a second medication into an empty syringe which has already been labelled with another medication. In addition to the aforementioned adverse affects, a unique situation of having a patient awake and aware during surgery can occur where a muscle relaxant is inappropriately dosed. 
     Thus, there is a constant need for improvement in eliminating errors in the selection, and administering, of injectable medications for the safety and life of the recipients of the medications. 
     SUMMARY OF THE INVENTION 
     It is, therefore, an object of this invention to provide a coded injectable fluid medication which is identifiable, and methods of identifying the coded injectable fluid medication, by the visual appearance thereof. 
     Another object of this invention is to provide coded injectable fluid medications for, and methods of, distinguishing between at least two different injectable fluid medications by the visual appearances of the medications. 
     With these and other objects in mind, this invention contemplates a coded injectable fluid medication identifiable by a coded visual appearance thereof, for use in the treatment, in some instances, of humans, and, in other instances, of animals, both humans and animals being referred to hereinafter as “patients.” An injectable fluid medication has a prescribed efficacy and an initial visual appearance, and is selected from the classes of pharmaceuticals consisting of barbiturates, benzodiazepines, opioids, anesthetics, Etomidate and derivatives thereof, local anesthetics, muscle relaxants, cardiovascular medications, antihistamines, anticholinergics, anticholinesterases, antitoxins/antidotes, electrolytes, anticoagulants and its reversal agents, thrombolytics, butyrophenones, antibiotics, antiseizure medications, chemotherapeutics, contrast media, radiologic agents, tranquilizers, hormones, emetics, immunosuppressants, antineoplastics, cardiac glycosides, nonsteriodal anti-inflammatories, antiemetics, immunoregulants, vitamins, anticonvulsants, antiparasitics, diuretics, vaccines, antiarthritics, steroidal anti-inflammatories, sedatives, thiazines, hypnotics, respiratory stimulants, alpha-2 adrenergic antagonists, and antivenoms. 
     The above-listed classes of pharmaceuticals will be referred to hereinafter as “the above-noted classes of pharmaceuticals.” A selected substance is dissolved in the injectable fluid medication, without altering the prescribed efficacy of the injectable fluid medication, to produce an altered visual appearance of the injectable fluid medication which is different from the initial visual appearance. The selected substance is selected from any one or more substances of a group of substances which will alter the visual appearance of the injectable fluid medication, and which have been approved by the Food and Drug Administration of the U.S. Department of Health and Human Services for injection into human beings. 
     This invention further contemplates a first coded injectable fluid medication and a second coded injectable fluid medication, which is a different medication from the first coded injectable fluid medication, coded by the visual appearances thereof, for distinguishing the first coded injectable fluid medication from the second coded injectable fluid medication, for use in the treatment of patients. The first injectable fluid medication has a prescribed efficacy and an initial visual appearance, and is selected from the above-noted classes of pharmaceuticals. A selected substance is dissolved in the first injectable fluid medication, without altering the prescribed efficacy of the injectable fluid medication, to produce an altered visual appearance of the first injectable fluid medication which is different from the initial visual appearance of the first injectable fluid medication. The selected substance is selected from any one or more substances of a group of substances which will alter the visual appearance of the injectable fluid medication, and which have been approved by the Food and Drug Administration of the U.S. Department of Health and Human Services for injection into human beings The second injectable fluid medication has a prescribed efficacy and an initial visual appearance which is different from the altered visual appearance of the first injectable fluid medication, where the second injectable fluid medication is selected from the above-noted classes of pharmaceuticals. 
     This invention also contemplates the provision of a first coded injectable fluid medication and a second coded injectable fluid medication, which is a different medication from the first coded injectable fluid medication, coded by the visual appearances thereof, for distinguishing the first coded injectable fluid medication from the second coded injectable fluid medication. The selected substance, noted in the preceding paragraph, is a first selected substance, and a second selected substance, different from the first selected substance, is dissolved in the above-noted second injectable fluid medication. The dissolving of the second selected substance does not alter the prescribed efficacy of the second injectable fluid medication, and produces an altered visual appearance of the second injectable fluid medication which is different from the initial visual appearance of the second injectable fluid medication, and different from the altered visual appearance of the first injectable fluid medication. The second selected substance is selected from any one or more substances of a group of substances which will alter the visual appearance of the second injectable fluid medication, and which have been approved by the Federal Drug Administration of the U.S. Department of Health and Human Services for injection into human beings. 
     In addition, this invention contemplates the provision of a method of preparing a coded injectable fluid medication identifiable by the visual appearance thereof. This method includes providing an injectable fluid medication having a prescribed efficacy and an initial visual appearance, which is selected from the above-noted classes of pharmaceuticals. The method further includes providing a selected substance which, when dissolved in the injectable fluid medication, without altering the prescribed efficacy of the injectable fluid medication, will produce an altered visual appearance of the injectable fluid medication which is different from the initial visual appearance, where the selected substance is selected from any one or more substances of a group of substances which will alter the visual appearance of the injectable fluid medication, and which have been approved by the Federal Drug Administration of the U.S. Department of Health and Human Services for injection into human beings. The method also includes dissolving the selected substance in the injectable fluid medication to produce the altered visual appearance of the injectable fluid medication. 
     This invention further contemplates the provision of a method for preparing a first coded injectable fluid medication and a second coded injectable fluid medication, which is a different medication from the first coded injectable fluid medication, and for distinguishing the first coded injectable fluid medication from the second coded injectable fluid medication, by the visual appearances thereof, for use in the treatment of patients. This method includes providing the first injectable fluid medication, which has a prescribed efficacy and an initial visual appearance, and is selected from the above-noted classes of pharmaceuticals. Further, this method includes providing a selected substance which, when dissolved in the first injectable fluid medication, without altering the prescribed efficacy of the injectable fluid medication, will produce an altered visual appearance of the first injectable fluid medication which is different from the initial visual appearance of the first injectable fluid medication. The selected substance is selected from any one or more substances of a group of substances which will alter the visual appearance of the injectable fluid medication, and which have been approved by the Federal Drug Administration of the U.S. Department of Health and Human Services for injection into human beings. This method also includes providing the second injectable fluid medication, which has a prescribed efficacy, and an initial visual appearance, which is different from the altered visual appearance of the first injectable fluid medication. The second injectable fluid medication is selected from the above-noted classes of pharmaceuticals. 
     This invention also contemplates the provision of a method, wherein the selected substance, noted in the preceding paragraph, is a first selected substance. This method includes providing a second selected substance, different from the first selected substance. The second selected substance is dissolvable in the second injectable fluid medication, without altering the prescribed efficacy of the second injectable fluid medication, and will produce an altered visual appearance of the second injectable fluid medication which is different from the initial visual appearance of the second injectable fluid medication, and different from the altered visual appearance of the first injectable fluid medication. The second selected substance is selected from any one or more substances of a group of substances which will alter the visual appearance of the second injectable fluid medication, and which have been approved by the Federal Drug Administration of the U.S. Department of Health and Human Services for injection into human beings. The method further includes dissolving the second selected substance in the second injectable fluid medication to produce the altered visual appearance of the second injectable fluid medication, which is different from the altered visual appearance of the first injectable fluid medication. 
     Other objects, features and advantages of the present invention will become more fully apparent from the following detailed description of the preferred embodiment and the appended claims. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       In the accompanying drawings: 
         FIG. 1  is a perspective view showing a prior art two-compartment intravenous bag; 
         FIG. 2  is a sectional view showing a prior art two-compartment vial; and 
         FIG. 3  is a partial sectional view showing the prior art vial of  FIG. 2 . 
     
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENT OF THE INVENTION 
     For many years, in the current system of providing the many different injectable medications used for medical treatment of patients, pharmaceutical companies have manufactured the different injectable medications with a clear visual appearance. The clear medications are placed in a container such as, for example, a vial, an ampule, a pre-filled syringe, an intravenous bag, or the like prior to shipping the medications to pharmacies, hospitals, and the like. However, without some form of identification, each clear medication, in each container, would be indistinguishable from the many remaining different containerized medications with a clear visual appearance. 
     In an effort to identify and distinguish the different clear injectable medications, the pharmaceutical companies have used various techniques externally of the container to identify and distinguish the many clear medications. Such techniques include placing a pre-printed label on each container, with the name of the medication printed on the label, printing bar codes on the label unique to the medication within the container, and using labels, and/or container caps, of different colors based on a color code scheme unique to the medication within the containers. 
     In preparation for, and during, a medical procedure for a patient, an anesthesiologist, or any medical professional, i.e., a physician, a nurse, or a paramedic, will draw up different clear injectable medications into respectively different syringes, or into a common syringe, labeled or unlabeled. In similar fashion, intravenous bags may be prepared prior to, or during, the medical procedure. Once the clear medications have been withdrawn from the labeled containers, the ability to identify and distinguish between different syringe-loaded, or intravenous bag-loaded, medications is lost. 
     In an attempt to avoid mistakes in the use of such medication-loaded syringes and bags, the anesthesiologists, or medical professionals, typically place a section of tape on the syringes and bags, and may hand-write, on the tape, the name of the drug. Even then, mistakes occur resulting in potential harm to the patient. 
     The above-described, currently available techniques and facilities, which are external to the medication, i.e., on the outside of the container, syringe and/or intravenous bag, are prone to human error, and require time-consuming reading and analysis by the handlers and users thereof, which, in many crucial situations, is time that they can ill afford. 
     Therefore, after many years of relying on the error-prone external techniques and facilities, as described above, to identify and distinguish between injectable medications in containers provided by the pharmaceutical manufacturers, and/or in syringes and intravenous bags prepared on site, the invention described and claimed herein presents a new and unique approach, wherein the different injectable medications are identified and distinguishable by the color of the medications. The handlers and professionals who come in contact with these colored injectable medications will be able to immediately identify and distinguish the different injectable medications by the visual appearance of the medications, internally of the container, rather than having to rely on the time-consuming reading and/or analyzation of the above-noted external facilities currently in use. 
     The visually clear, injectable medications, which are referred to hereinafter as “injectable fluid medications,” under this invention, are included in the above-noted classes of pharmaceuticals, and all such injectable fluid medications have a prescribed efficacy. 
     Some examples of visually clear, injectable fluid medications in each of these classes are listed below. Any visually clear, injectable fluid medications not listed below as examples, which are known to be in any one of the above-listed classes, are covered by the claims of this application. Each of the following classes of pharmaceuticals is listed and enumerated, followed by the examples of the visually clear, injectable fluid medications in each group:
     1. barbiturates—Phenobarbital, Pentobarbital;   2. benzodiazepines—Midazolam, Valium;   3. opioids—Morphine, Fentanyl;   4. anesthetics—Ketamine, Tribromo ethanol, Tiletamine;   5. Etomidate and derivatives thereof;   6. local anesthetics—Lidocaine, Bupivicaine, Ropivicaine;   7. muscle relaxants—Succinylcholine, Rocuronium, Vecuronium;   8. cardiovascular medications—Epinephrine, Ephedrine, Lopressor;   9. antihistamines—Benadryl, Promethazine;   10. anticholinergics—Atropine, Scopolamine, Glycopyrrolate;   11. anticholinesterases—Neostigmine, Pyridostigmine;   12. antitoxins/antidotes—Narcan, Flumazenil, Digibind, Sodium Thiosulsat;   13. anticoagulants and its reversal agents—Heparin, Protamine;   14. electrolytes—calcium, potassium, magnesium;   15. thrombolytics—Urokinase, Reteplase;   16. butyrophenones—Haloperidol, Droperidol;   17. antibiotics—Pencillin, Gentamicin;   18. antiseizure medications—Phenytoin;   19. chemotherapeutics—Cyclophosphamide, Carboplatin;   20. contrast media—Diatrizoate meglumine, Iodixanol;   21. radiologic agents—Tositumomab, Regadenoson;   22. tranquilizers—Acepromazine maleate;   23. hormones—ACTH, Insulin, Erythropoietin;   24. emetics—Apomorphine   25. immunosuppressants—Azathioprine, Chlorambucil;   26. antineoplastics—Cisplatin, Elspar;   27. cardiac glycosides—Digoxin;   28. nonsteroidal anti-inflammatories—Rimadyl, Banamine;   29. antiemetics—Metoclopramide, Cerenia, Centrine;   30. immunoregulants—Immunoregulin, Interferon alpha;   31. vitamins—Phytonadione;   32. anticonvulsants—Valium, Ativan;   33. antiparasitics—Praziquantel, Ivermectin;   34. diuretics—Furosamide;   35. vaccines—Bronchi-shield, Bronchicine, Duramun;   36. antiarthritics—Adequan, Polyglycan;   37. steroidal anti-inflammatories—Depo-medrol, Dexamethasone;   38. sedatives—Acepromazine, Droperidol;   39. thiazines—Xylazine, Medetomidine;   40. hypnotics—Alpha chloralose;   41. respiratory stimulants—Doxopram;   42. alpha-2 adrenergic antagonists—Yohimbine.   43. antivenoms—Rabies Immune Globulin   

     In the manner described below, a single known substance, or a combination of such known substances, are dissolved in the clear injectable fluid medications to alter the visual appearance from an initial, or clear, appearance to an altered, non-clear, or colored appearance. Each substance, which is also referred to below as a composition, is selected from a group of known substances which, when dissolved in a clear medication, or in water, will alter the visual appearance of the medication by producing a colored, or a non-clear, appearance unique to the substance, or unique to a combination of such substances. The above-noted group of known substances, which are covered in the claims of this application, are identified as those substances which the FDA has approved for injection into human beings. 
     The substances, selected from the above-noted group, will not alter the above-noted prescribed efficacy of the injectable fluid medications, when dissolved in the medications. As noted above, all of the substances, selected from the above-noted group of substances, have been approved by the FDA for injection into human beings. While the preferred form of the selected substances is powder, the form of the substances may also be liquid or solid without departing from the spirit and scope of the invention. 
     Examples of substances, approved by the FDA, in the above-noted group of substances, from which a selection can be made for producing a particular non-clear, or color, visual appearance, when dissolved in the injectable fluid medications, include, but are not limited to, such as compositions as indigotindisulfonate sodium, which produces a deep blue color; rocuronium bromide, which produces a yellow/orange color; methylene blue, which produces a blue color; pemetrexed disodium, which produces light yellow or green-yellow color; sodium ferric gluconate complex, which produces a deep red color; hydroxocobalamin, which produces a dark red color; and indocyanine green, which produces a green color. Any color-producing substances, in addition to the above-noted substances, which have been approved by the FDA for injection into human beings, are included as the substance of the herein described and claimed coded medications, and the methods of preparing same, without departing from the spirit and scope of the invention. 
     Any two or more of the color-producing substances approved by the FDA, including the above-noted substances, can be combined to produce other colors for use in altering the visual appearance of the clear injectable fluid medications, without departing from the spirit and scope of the invention. 
     The technique of coloring injectable fluid medications, as described and claimed herein, can be used in conjunction with a color code scheme wherein the visual appearance of each clear injectable fluid medication is altered with an assigned color unique to that medication, which is different from the colors assigned to the other medications, to identify individual medications, and to distinguish two or more different medications. A coded injectable fluid medication is identifiable by the visual appearance thereof, and includes as a portion thereof an injectable fluid medication, selected from the above-noted group of pharmaceuticals. The injectable fluid medication has a prescribed efficacy and an initial visual appearance, such as, for example, a clear appearance. 
     An appearance-altering substance, approved for injection into human beings by the FDA, is selected from any one or more of the above-noted group of substances, which, when dissolved in the injectable fluid medication, will produce an altered visual appearance, different from the initial visual appearance of the medication, and without altering the prescribed efficacy of the medication. The substance is selected on the basis that the substance will alter the initial visual appearance of the injectable fluid medication to an altered visual appearance, which is unique to the medication in accordance with a coded scheme. 
     In order to obtain the desired altered visual appearance, a prescribed amount of the selected substance is dissolved in a prescribed amount of the clear injectable fluid medication, with the prescribed amounts of the substance and medication being determined by a prescribed ratio of the amounts of the substance and the medication necessary to produce the desired non-clear, or colored, visual appearance. 
     The selected substance is then dissolved in the injectable fluid medication, whereby the initial visual appearance is altered to a non-clear appearance indicative of the injectable fluid medication in accordance with the coded scheme. As an example, when the selected substance is dissolved in the initial clear appearance of the injectable fluid medication, the initial clear visual appearance of the medication is altered to a non-clear, or colored, visual appearance, which is unique to the medication in accordance with the code scheme. 
     The above-noted initial visual appearance of the injectable fluid medication can be a clear appearance and the altered visual appearance thereof can be a non-clear appearance, which could be a colored appearance, all without departing from the spirit and scope of the invention. In addition, as noted above, the selected substance can be selected from a group of any one, or a mixture of two or more, compositions, which, when dissolved in the injectable fluid medication will change the initial visual appearance of the injectable fluid medication to a selected non-clear, or colored appearance. Further, as noted above, the form of the selected substance can be a fluid, a powder, or be solid. 
     Preferably, the selected substance is dissolved in the injectable fluid medication at the manufacturing site of the pharmaceutical company. In this manner, large volumes of the injectable fluid medication can be treated with the dissolved substance to provide the large volume of coded medication. Measured amounts of the coded medication can then be dispensed, in a conventional manner, into measured containers, such as vials, ampules, syringes, intravenous bags, and the like. The measured containers can then be shipped to receiving locations such as pharmacies, hospitals, and the like. 
     As illustrated in  FIG. 1 , a container, such as a prior art intravenous bag  10 , is formed with a first compartment  12  and a second compartment  14 , which is segregated from the first compartment by a divider wall  16 . A flexible sleeve  18  is located within the divider wall  16  to facilitate communication between the first compartment  12  and the second compartment  14 , but precludes such communication by a breakable seal  20 , which is located within the sleeve. By squeezing the sleeve  18 , externally of the bag  10 , the seal  20  is broken to allow communication between the first compartment  12  and the second compartment  14 . The prior art intravenous bag  10  is illustrated and described in U.S. Pat. No. 5,853,388, which is incorporated herein by reference thereto. 
     As illustrated in  FIGS. 2 and 3 , a container, such as a prior art vial  26 , is formed with a first compartment  28  and a second compartment  30 , which are sealed from communication therebetween by a compliant plug  32  located removably in a central neck  34  of the vial. A closure structure  36  is mounted on an open end  38  of the vial  26 , and includes a resilient flexible stopper  40 , which fits into, and seals, the open end of the vial. A dust seal  42  is located at an outer top of the closure structure  36 , and is normally in an inactivated position as shown in  FIG. 2 . By pressing on the outer top surface of the dust seal  42 , to move the dust seal toward the vial  26  to a position shown in  FIG. 3 , the stopper  40  is moved farther into the second compartment  30  of the vial to compress the volume of the second compartment. As the volume of the second compartment  30  is being compressed, the force of compression is applied against the plug  32  to move the plug into the first compartment  28 , whereby the first compartment is in communication with the second compartment. The prior art vial  26  is illustrated and described in U.S. Pat. No. 4,258,845, which is incorporated herein by reference thereto. 
     As an alternative to fully preparing the coded injectable fluid medication at the pharmaceutical companies, a container having a first compartment and a second compartment, such as, for example, the prior art containers  10  and  26  described above, can be used. Such a container would be formed with a first compartment and a second compartment, which can be segregated by a releasable seal. 
     With the seal not in place, a prescribed amount of the selected substance is loaded into the first compartment, and the seal is put in place to segregate the first compartment from the second compartment. A prescribed amount of the injectable fluid medication is deposited into the second compartment. Means are attached to the container for facilitating opening of the seal, so that the selected substance dissolves in the injectable fluid medication to produce the altered visual appearance thereof. The opening, or breaking, of the seal can be effected at any desired location, such as, for example, the site of injecting the medication into the patient. 
     Whether the selected substance is dissolved in the injectable fluid medication at the pharmaceutical facilities, or at any other location, such as, for example, a pharmacy or hospital, a coded injectable fluid medication is formed, and is identifiable by the altered visual appearance. 
     The principle of the above-described coded injectable fluid medication can be used to distinguish between two, or amongst several, injectable fluid medications. The description below will be directed to the distinguishment between a first coded injectable fluid medication and a second coded injectable fluid medication, which is a different medication from the first injectable fluid medication. It is understood that below-described principle regarding distinguishing between two medications, can be used to distinguish amongst three or more medications, without departing from the spirit and scope of the invention. 
     A selected substance is dissolved in a first injectable fluid medication in the manner described above, with respect to the identification of the medication, to produce an altered visual appearance. A second injectable fluid medication is selected from the above-noted classes of pharmaceuticals, and has a prescribed efficacy and an initial visual appearance, which is different from the altered visual appearance of the first injectable fluid medication. The first injectable fluid medication is distinguished from the second injection fluid medication by having an altered visual appearance which is different from the initial visual appearance of the second injectable fluid medicine. 
     With respect to the above-noted distinguishment between the first medication and the second medication, the initial visual appearances of the first and second injectable fluid medications are each a clear visual appearance. 
     Further, with respect to the above-noted distinguishment between the first medication and the second medication, the selected substance which was dissolved in the first injectable fluid medication is a first selected substance. A second selected substance, different from the first selected substance, is dissolved in the second injectable fluid medication, without altering the efficacy of the second fluid medication, to produce an altered visual appearance which is different from the initial visual appearance of the second injectable medication, and different from the altered visual appearance of the first injectable fluid medication, to provide distinguishing altered visual appearances between the first and second injectable fluid medications. The second selected substance is selected from any one or more substances of the above-noted group of substances, which will alter the visual appearance of the second injectable fluid medication, and which have been approved, by the FDA, for injection into human beings. 
     Further, with respect to the above-noted distinguishment between the first injectable fluid medication and the second injectable fluid medication, by dissolving, respectively, the first selected substance and the second selected substance therein, the first injectable fluid medication and the second injectable fluid medication are generally the same volume, and the first and second selected substances are the same substance. The volume of the same substance dissolved in the first injectable fluid medication is less than the volume of the same substance dissolved in the second injectable fluid medication to produce different altered visual appearances between the first and second injectable fluid medications. In this manner, the first and second injectable fluid medicines are distinguishable by different shades of the same color. 
     In addition, with respect to the above-noted distinguishment between the first injectable fluid medication and the second injectable fluid medication, by dissolving, respectively, the first selected substance and the second selected substance therein, the initial visual appearance is a clear appearance, and the altered visual appearance thereof is a first non-clear appearance. The initial visual appearance of the second injectable fluid medication is a clear visual appearance, and the altered visual appearance thereof is a second non-clear appearance, which is different from the first non-clear visual appearance. The first altered visual appearance can be a first color, and the second altered visual appearance can be a second color different from the first color. Also, the first color and the second color can be the same, with a shade of the first color being different from a shade of the second color. Further, the form of each of the first selected substance and the second selected substance can be a fluid, a powder, or a solid. 
     This technique could be used where the first and second injectable fluid medications are different medications, but are in the different classes of the pharmaceuticals noted above. For example, in the above listing of the different classes of pharmaceuticals, barbiturates is one class with the medication phenobarbital, and opioids is another class with the medication morphine. Thus, even though the medications are in different groups of pharmaceuticals, different shades of the color can be used to identify the different medications in different classes, for example, a light shade of the color for phenobarbital, and a dark shade of the color for morphine. 
     This technique could be used where the first and second injectable fluid medications are different medications, but are in the same class of pharmaceuticals noted above. For example, in the above listing of the different classes of pharmaceuticals, phenobarbital and pentobarbital are different injectable fluid medications, but both are in the barbiturates class. Thus, a given color can be assigned in a color code scheme to identify a given group, for example, barbiturates, and different shades of the given color can be used to identify the different medications within the given class, for example, a light shade of the color for phenobarbital, and a dark shade of the color for pentobarbital. In another technique, the volume of the first injectable fluid medication is less than the volume of the second injectable fluid medications by a prescribed ratio, and the first and second selected substances are the same substance. The volume of the same substance dissolved in the first injectable fluid medication is less than the volume of the same substance dissolved in the second injectable fluid medication by the prescribed ratio, to produce different altered visual appearances between the first and second injectable fluid medications. 
     The first injectable fluid medication and the first selected substance can be placed in a first two-compartment container in the manner noted above, and, in similar fashion, the second injectable fluid medication and the second selected substance can be placed in a second two-compartment container in the same manner as placement of the first medication and the first selected substance in the first two-compartment container. 
     In the context of the methods of preparing the coded injectable fluid medications, such methods are inherent in the description above regarding the identification of the coded injectable fluid medication, and regarding the distinguishment between two different coded injectable fluid medications. Also, the properties and various visual appearances of the medications and the properties of the substances, which are set forth herein in some of the method claims, are described above. 
     In the preparation of a coded injectable fluid medication, an injectable fluid medication, defined above, and a selected substance, also defined above, are provided. The selected substance is then dissolved in the medication. Further, two-compartment containers, each with releasable seals, are provided for segregated placement of the injectable fluid medications and the selected substances in the segregated compartments, with facilities attached to the containers to facilitate opening of the seals. Further, the seals are opened to facilitate dissolving the substances in the medications. 
     In the preparation of two coded injectable fluid medications for distinguishment therebetween, a first injectable fluid medication, a selected substance, and a second injectable medication are provided. Further, the selected substance is dissolved in the first injectable fluid medication. Also, a second selected substance is provided. The second selected substance is dissolved in the second injectable fluid medication. 
     As described above, and claimed below, a coded injectable fluid medication is identifiable by the visual appearance of the medication, and methods of preparing the coded medication are provided. Further, two, or more, coded injectable fluid medications are distinguishable by the difference in their visual appearances, and methods of preparing the two medications are provided. By use of the visual appearance of the coded injectable fluid medications, the effort to eliminate the medication-selection errors, which, in the past, have resulted in injury, and even death, to patients, is significantly enhanced. 
     In general, the above-identified embodiments are not to be construed as limiting the breadth of the present invention. Modifications, and other alternative constructions, will be apparent which are within the spirit and scope of the invention as defined in the appended claims.