Standardizing the Storage and Labelling of Medications: Part 1 (original) (raw)
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BMJ Quality & Safety, 2017
Background Medication errors are frequent and may cause harm to patients and increase healthcare expenses. Aim To explore whether a new labelling influences time and errors when preparing medications in accordance with medication charts in an experimental setting. Method We carried out an uncontrolled before and after study with 3 months inbetween experiments. Phase I used original labelling and phase II used new generic labelling. We set up an experimental medicine room, simulating a real-life setting. Twenty-five nurses and ten pharmacy technicians participated in the study. We asked them to prepare medications in accordance with medication charts, place packages on a desk and document the package prepared. We timed the operation. Participants were asked to prepare medications in accordance with as many charts as possible within 30 min. Results Nurses prepared significantly more medication charts with the generic labelling compared with the original 3.3 versus 2.6 (p=0.009). Mean time per medication chart was significantly lower with the generic labelling 6.9 min/chart versus 8.5 min/chart (p<0.001). Pharmacy technicians were significantly faster than the nurses in both phase I (6.8 min/chart vs 9.5 min/chart; p<0.001) and phase II (6.1 min/ chart vs 7.2 min/chart; p=0.013). The number of errors was low and not significantly different between the two labellings, with errors affecting 9.1% of charts in phase I versus 6.5% in phase II (p=0.5). Conclusions A new labelling of medication packages with prominent placement of the active substance(s) and strength(s) in the front of the medication package may reduce time for nurses when preparing medications, without increasing medication errors.
Labeling of Medicines and Patient Safety: Evaluating Methods of Reducing Drug Name Confusion
Human Factors, 2006
Objective: We report three experiments evaluating the proposal that highlighting sec- tions of drug names using uppercase (“tall man”) lettering and/or color may reduce the confusability of similar drug names. Background: Medication errors commonly involve drug names that look or sound alike. One potential method of reducing these errors is to highlight sections of names on labels in order to emphasize the differences between similar products. Method: In Experiments 1 and 2, participants were timed as they decided whether similar name pairs were the same name or two different names. Experiment 3 was a recognition memory task. Results: Results from Experiments 1 and 2 showed that highlighting sections of words using tall man lettering can make similar names easier to distinguish if participants are aware that this is the purpose of the intervention. Results from Experiment 3 suggested that tall man lettering and/or color does not make names less confusable in memory but that tall man letters may increase attention. Conclusion: These findings offer some support for the use of tall man letters in order to reduce errors caused by confusion between drug products with look-alike names. Application: The use of tall man letters could be applied in a vari- ety of visual presentations of drug names – for example, by manufacturers on packag- ing, labeling, and computer software, and in pharmacies on shelf labels. Additionally, this paper demonstrates two meaningful behavioral measures that can be used during product design to objectively assess confusability of packaging and labeling.
Medication labeling practices at in-patient hospital pharmacies: the present dilemma in Pakistan
MOJ Drug Design Development & Therapy
Drug labels provide first hand information to the patients as well as it provides a unique identity to the medical product. Misreading the label, inadequate information on label, inappropriate labeling font, writing style and its placement on the dosage form are the few of the barriers identified for inappropriate labeling practices. Objective: The main objective of the present study was to assess current labeling practices in inpatient departments of health care facilities among public and private sectors in twin cities of Pakistan. Methodology: A descriptive cross-sectional study design was used. A total of twenty healthcare facilities were randomly selected i.e. 10 from public and 10 from private sectors. As per WHO criteria thirty encounters per facility were observed. ISMP guidelines were used to develop a structured observation form. After data collection, data was recorded on structured observation form containing predetermined set of indicators. After data collection, data was cleaned, coded and entered in SPSS version 21. Descriptive statistics of frequency and percentages were calculated. Kruskal-Wallis and Mann-Whitney tests (p≤0.05) were performed to find out differences among variables. Results: Out of total hospitals visited only 10% were having proper IPD pharmacy setup in public sector while in private sector 50% were having proper IPD pharmacy setup. Significant differences (p≤0.05) were found among the labeling practices carried for label identification, label instruction and label layout with respect to city, sector, gender, designation, age, experience and dosage form. Labeling practices carried in private sector and healthcare facilities located in Islamabad were comparatively better than the public sector and healthcare facilities located in Rawalpindi. Pharmacists had relatively more compliance with the standard labeling guidelines. Conclusion: The present study concluded that the labeling practices carried at the hospital pharmacies were not up to the mark. Although labeling practices in terms of labeling identification was appropriately mentioned but labeling instructions and layout were not in compliance with the standard labeling guidelines. This might be due to lack of availability/implementation of national standard labeling guidelines, lack of interest, knowledge and training of dispensers regarding good labeling practices.
Are Prescription Labels Usable? A Review and Analysis
Lecture Notes in Computer Science, 2013
There are approximately 400,000 adverse drug events per year in hospitalized patients which has resulted in more than $ 3.5 billion spent in subsequent recovery care. The present paper reviews the literature relating to the usability of information found on pharmaceutical labels. In particular, we examine the legibility and comprehensibility of the information provided on the labels. In addition, we highlight the differences in the physical makeup of medication that can be implemented to help users identify their medication. Finally, we provide recommendations for factors that should be examined in future research to improve the usability of pharmaceutical labels. Presently, the FDA has few standards and guidelines regarding the content and layout of a prescription label. We hope that the recommendations provided in this paper can lead to the development of standards for formatting and presenting information on prescription labels that will reduce the number of medical cases involving ingestion of the wrong medication.
Current practices for labeling medications in hospitals in Riyadh, Saudi Arabia
Saudi Pharmaceutical Journal, 2013
Background: Good medication labeling practices are imperative to ensure safe medication use. Non-adherence to labeling protocols is reported as one major source of medication errors. Objective: This study was intended to evaluate and compare adherence to labeling guidelines for dispensed medications among the hospitals of the five different health sectors in the city of Riyadh, Saudi Arabia. Methods: A descriptive, cross-sectional analysis was conducted among 14 public hospitals in the city of Riyadh, Saudi Arabia. Labeling guidelines issued by the Institute for Safe Medication Practices were used as a standard assessment tool. A total of 218 medication labels were collected and evaluated for labeling adequacy. Descriptive statistics were used to elaborate the study findings. All analyses were performed with Microsoft Access. Results: The study showed a substantial rate of adherence to the labeling guidelines. In terms of the established criteria, community and mail orders were reported to adhere strongly (90.5%), whereas injectables adhered least to the labeling guidelines. The labeling format, contents of the label, instructions on the labels, abbreviations used on the labels and drug names were also consistent with the guidelines (80.0%, 84.0%, 88.0%, 97.7% and 85.5%, respectively). Organizations
2014
Several studies have addressed the need for pharmaceutical companies to improve medication labelling.1,2 Criticisms have generally related to small font size, poorly designed and visually cluttered labels, and inadequate warnings.1 In addition, similarities between medication names (i.e., look- and sound-alike names) and labels (i.e., look-alike packaging), as well as unsafe storage practices, have been cited as contributing to medication incidents and errors.3,4 Coupled with research in human factors, this information can prompt and guide health care organizations to improve labelling in medication storage areas. Building on our previous article, which outlined an initiative within the Calgary Health Region to simplify the storage of medications,5 the current article highlights specific improvements in medication labelling that were made in the inpatient care and pharmacy areas in an effort to enhance safety and improve efficiency.
Prescription Drug Labeling Medication Errors: A Big Deal for Pharmacists
Today, in the health care profession, all types of medication errors including missed dose, wrong dosage forms, wrong time interval, wrong route, etc., are a big deal for better patient care. Today, problems related to medications are common in the healthcare profession, and are responsible for significant morbidity, mortality, and cost. Several recent studies have demonstrated that patients frequently have difficulty in reading and understanding medication labels. According to the Institute of Medicine report, “Preventing Medication Errors”, cited poor labeling as a central cause for medication errors in the USA. Evidence suggests that specific content and format of prescription drug labels facilitate communication with and comprehension by patients. Efforts to improve the labels should be guided by such evidence, although an additional study assessing the influence of label design on medication-taking behavior and health outcomes is needed. Several policy options exist to require minimal standards to optimize medical therapy, particularly in light of the new Medicare prescription drug benefit. Key words: Health care profession, labeling, medication error
Improving the usability of intravenous medication labels to support safe medication delivery
International Journal of Industrial Ergonomics, 2011
Medication label design is frequently a contributing factor to medication errors. Design regulations and recommendations have been predominantly aimed at manufacturers' product labels. Pharmacy-generated labels have received less scrutiny despite being an integral artifact throughout the medication use process. This article is an account of our efforts to improve the design of a hospital's intravenous (IV) medication labels. Our analysis revealed a set of interrelated processes and stakeholders that restrict the range of feasible label designs. The technological and system constraints likely vary among hospitals and represent significant barriers to developing and implementing specific design standards. We propose both an ideal IV label design and one that adheres to the current constraints of the hospital under study.
Analysis of similar drug labeling: potential medication errors
Revista da Associação Médica Brasileira, 2012
Objective: This study aimed to examine drug packaging and labeling, identifying similarities among them that may lead to medication errors, which may occur by unintentional substitution, in different sectors of the pharmacy of a university hospital in northeastern Brazil. Methods: Cross-sectional observational study, which included 300 pharmaceutical presentations (150 pairs) that were photographed from May to December 2010. Concordance analysis of data related to the pictures of possibly similar packaging and labels was validated using the Kappa index. Results: Of all drugs evaluated (n = 150), about 43% of "possibly similar drugs" were in the central pharmacy (n = 65) and were related to small-volume parenteral solutions. The strength of interobserver agreement in the category "very similar to each other" was considered "satisfactory" (Kappa = 0584) in 90.66% of the drugs evaluated (n = 136). The overall Kappa analysis of the study was 0.488. Variables with statistical significance were: "same color label or packaging", with the respective percentages for both primary and secondary packaging (52%-44%), p = 0.028; the variable "same color of drug presentation" obtained similar values and statistical significance to the previous variable; for the variable "same arrangement of words", the values found for both packages were close to 50%, p = 0.001; and for the variable "same color of the words", the percentages were: (50.7% -44%) (p = 0.008). Conclusion: Our results indicate similarities related to the labeling of drugs with potential for errors, especially in dispensing, storage, and administration if preventive measures are not adopted.