To err is human: Patient misinterpretations of prescription drug label instructions

Wolf, Michael S.; Davis, Terry C.; Shrank, William H.; Rapp, David N.; Bass, Pat F.; Connor, Ulla; Clayman, Marla L.; Parker, Ruth M.

doi:10.1016/j.pec.2007.03.024

Cited by 251 publications

(220 citation statements)

References 20 publications

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“…[11][12][13][14][15] While health care providers should avoid using atypical terms such as cubic centimeters, there are concerns about eliminating familiar terms such as teaspoon or tablespoon. Although parents may be comfortable using teaspoon and tablespoon units, parents mix up these terms, contributing to threefold errors (1 teaspoon = 5 mL; 1 tablespoon = 15 mL) [16][17][18][19] ; abbreviations are easily confused (eg, tsp versus tbsp). 10,16 In addition, teaspoon and tablespoon units may inadvertently endorse the use of kitchen spoons, which vary widely in size and shape, making it difficult for parents to measure their intended dose.…”

Section: Discussionmentioning

confidence: 99%

Unit of Measurement Used and Parent Medication Dosing Errors

et al. 2014

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BACKGROUND AND OBJECTIVES: Adopting the milliliter as the preferred unit of measurement has been suggested as a strategy to improve the clarity of medication instructions; teaspoon and tablespoon units may inadvertently endorse nonstandard kitchen spoon use. We examined the association between unit used and parent medication errors and whether nonstandard instruments mediate this relationship. METHODS: Cross-sectional analysis of baseline data from a larger study of provider communication and medication errors. English- or Spanish-speaking parents (n = 287) whose children were prescribed liquid medications in 2 emergency departments were enrolled. Medication error defined as: error in knowledge of prescribed dose, error in observed dose measurement (compared to intended or prescribed dose); >20% deviation threshold for error. Multiple logistic regression performed adjusting for parent age, language, country, race/ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease; site. RESULTS: Medication errors were common: 39.4% of parents made an error in measurement of the intended dose, 41.1% made an error in the prescribed dose. Furthermore, 16.7% used a nonstandard instrument. Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2–4.4) and prescribed (45.1% vs 31.4%, P = .04; adjusted odds ratio=1.9; 95% confidence interval, 1.03–3.5) dose; associations greater for parents with low health literacy and non–English speakers. Nonstandard instrument use partially mediated teaspoon and tablespoon–associated measurement errors. CONCLUSIONS: Findings support a milliliter-only standard to reduce medication errors.

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Section: Discussionmentioning

confidence: 99%

Unit of Measurement Used and Parent Medication Dosing Errors

et al. 2014

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“…32,35,36 Showback may be especially effective when a patient is expected to undertake a specific task. For example, having a patient count out the number of daily pills, 37 or demonstrate with oral syringe how much liquid medication will be given, 38 can be helpful to ensure patient understanding.…”

Section: Health Literacy As Part Of the Clinical Encountermentioning

confidence: 99%

Health Literacy: An Educationally Sensitive Patient Outcome

et al. 2015

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We have previously proposed that by identifying a set of Educationally Sensitive Patient Outcomes (ESPOs), medical education outcomes research becomes more feasible and likely to provide meaningful guidance for medical education policy and practice. ESPOs are proximal outcomes that are sensitive to provider education, measurable, and linked to more distal health outcomes. Our previous model included Patient Activation and Clinical Microsystem Activation as ESPOs. In this paper, we discuss how Health Literacy, defined as Bthe degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,^is another important ESPO. Between one-third and one-half of all US adults have limited health literacy skills. Providers can be trained to adopt a Buniversal precautions approach^to addressing patient health literacy, through the acquisition of specific skills (e.g., teachback, Bchunking^infor-mation, use of plain language written materials) and by learning how to take action to improve the Bhealth literacy environment.^While there are several ways to measure health literacy, identifying which measurement tools are most sensitive to provider education is important, but challenging and complex. Further research is needed to test this model and identify additional ESPOs.

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“…Previous research has demonstrated that many adults, particularly those with lower literacy skills, struggle to understand prescription drug labels. 90 Confusion arises when difficult language, graphics, numerical concepts, and distracting marketing information are encountered. 16,[90][91][92][93][94][95][96] Overall, poorly designed labeling has been deemed to be a contributor to one third of medication errors evaluated by the US Pharmacopeia.…”

Section: Patient Safety and Medication Errorsmentioning

confidence: 99%

“…90 Confusion arises when difficult language, graphics, numerical concepts, and distracting marketing information are encountered. 16,[90][91][92][93][94][95][96] Overall, poorly designed labeling has been deemed to be a contributor to one third of medication errors evaluated by the US Pharmacopeia. 81 Furthermore, accompanying written drug information given to patients and caregivers, including consumer medication information leaflets, package inserts, and US Food and Drug Administration (FDA) medication guides, is typically at a Ն10th-grade reading level, 96,97 which is too high for the majority of the US population.…”

Section: Patient Safety and Medication Errorsmentioning

confidence: 99%

Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety

Rothman

Yin²,

Mulvaney³

et al. 2009

Pediatrics

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Despite a heightened focus on improving quality, recent studies have suggested that children only receive half of the indicated preventive, acute, or chronic care. Two major areas in need of improvement are chronic illness care and prevention of medical errors. Recently, health literacy has been identified as an important and potentially ameliorable factor for improving quality of care. Studies of adults have documented that lower health literacy is independently associated with poorer understanding of prescriptions and other medical information and worse chronic disease knowledge, self-management behaviors, and clinical outcomes. There is also growing evidence to suggest that health literacy is important in pediatric safety and chronic illness care. Adult studies have suggested that addressing literacy can lead to improved patient knowledge, behaviors, and outcomes. Early studies in the field of pediatrics have shown similar promise. There are significant opportunities to evaluate and demonstrate the importance of health literacy in improving pediatric quality of care. Efforts to address health literacy should be made to apply the 6 Institute of Medicine aims for quality-care that is safe, effective, patient centered, timely, efficient, and equitable. Efforts should also be made to consider the distinct nature of pediatric care and address the "4 D's" unique to child health: the developmental change of children over time; dependency on parents or adults; differential epidemiology of child health; and the different demographic patterns of children and their families. The views presented in this article are those of the authors, not the organizations with which they are affiliated.www.pediatrics.org/cgi

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To err is human: Patient misinterpretations of prescription drug label instructions

Cited by 251 publications

References 20 publications

Unit of Measurement Used and Parent Medication Dosing Errors

Unit of Measurement Used and Parent Medication Dosing Errors

Health Literacy: An Educationally Sensitive Patient Outcome

Health Literacy and Quality: Focus on Chronic Illness Care and Patient Safety

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