WEST POINT, Pa., June 28, 2006 (PRIMEZONE) -- Difficulty in identifying tablets leads to patient and caregiver mistakes in administering the right medication and is a leading cause of pharmacy dispensing errors, according to a recent nationwide survey of 150 pharmacists. At the same time, pharmacists believe that tablets with a distinct color and shape and any identifying imprint will reduce medication errors, a significant health problem.
The Institute of Medicine estimates that preventable medication errors result in more than 7,000 deaths each year both in and outside of hospitals(1). "Add the financial cost to the human tragedy, and medication error easily rises to the top ranks of urgent, widespread public problems," affirms the National Coordinating Council for Medication Error Reporting and Prevention(2). In addition, the aging population and growing number of new treatments available have led to an ever-increasing number of medicines being prescribed, compounding the risk of mistaken tablet identification and subsequent noncompliance. As a result, pharmacists have had to become increasingly skilled at trying to identify them(3).
The majority (nearly 80%) of pharmacists participating in the survey believe that multiple look-alike medications contribute to difficulties patients and caregivers have in identifying medications. This is more likely to occur when patients transfer their medications to unlabeled containers. With an average rating of 8.3, on a 0-10 agreement scale, they agree that problems are multiplied when hard-to-distinguish tablets and capsules are removed from original dispensing bottles and placed into containers holding multiple medications.
Underscoring the importance of clear medication identification, the pharmacy boards of three states -- California, Wyoming and Oregon -- instituted regulations requiring that prescription medication container labels include the color, shape and any identification code appearing on the tablets or capsules.
"Clear identification of medications by both pharmacists and patients is extremely important in reducing medication error," said James Carder, Executive Director of the Wyoming Board of Pharmacy. "That is why Wyoming and other states instituted a regulation requiring a physical description on the label. As the number of discrete solid dose tablet offerings continues to grow, differentiation is becoming more difficult for pharmacists, nurses, physicians, patients and caregivers, and errors are hard to avoid when so many of these medications look alike. Clearly identifiable medicines can help reduce dispensing error, and help ensure patient safety and compliance."
Out of 12 tablet characteristics listed in the survey, on a scale of 1-12, with 1 being "most commonly used", pharmacists rated color (3.0) and shape (3.4) as the most common attributes patients and caregivers use to identify medications outside the original packaging. The next most common attribute was the numerical code (5.0) or drug name or logo printed on the tablet (5.7).
Look-alike medications (79% of respondents) and an unreadable code on the medication (74%) top the list of factors contributing to identification difficulties, followed by lack of company logo or product name (67%) or printed code (65%) on the tablet.
Pharmacists completely agree that one of their top concerns is the safety and well-being of patients and their ability to accurately take medications as prescribed. They believe pharmacists are best qualified to help patients and caregivers identify their medicines, and are the ones called upon most often to do so. Nearly 70% say that patients ask them to assist in identifying tablets or capsules outside the original packaging at least once a week. Nearly 40% of identification requests are from people ages 65-84, and 36% from ages 45-64.
The U.S. Food and Drug Administration (FDA) advises older adults who take more than one medicine to "be able to tell them apart by size, shape, color, number or name imprint, form (tablet or capsule), or container."(4)
Dispensing Errors
Pharmacists perceive that non-tablet factors such as physician handwriting, similar product names and package labeling are the leading causes of dispensing errors; however, tablet similarity is cited more than half the time (56%) as a contributing factor. On a scale of 0-10, with 10 being "extremely helpful," color is clearly preferred to standard white tablets, which averaged only a 1.4 rating. Furthermore, brightly colored tablets (rated 6.9) are seen as a significant improvement over pastel tablets (rated 3.0) in helping reduce medication error. Unique shapes (7.6) would also substantially differentiate tablets.
Other factors that reduce errors are a high-resolution imprint (rated 7.6) or drug name and dose etched into the tablet (deboss) (7.3), and contrasting color imprint (6.9). While not as strong an impact as color and shape, finish, such as pearlescence or gloss, are marginally helpful in identifying tablets. Flavor and aroma were believed to be slightly helpful (2.2 and 3.6 respectively).
A colored tablet with a unique shape, pearlescent finish, drug name and dose imprint, aroma and flavor is the best combination of characteristics, resulting in an eight-fold improvement in helping identify medications and reducing errors.
Another survey, conducted by an expert committee of the U.S. Pharmacopeia, the official public standards-setting authority for prescription and over-the-counter medicines, indicated that practitioners and pharmacists believe that current tablet identification tools should be improved and that the industry and FDA should work together toward this goal(5).
About the Survey
Personal Web-based interviews were conducted with 150 full-time, registered pharmacists throughout the U.S. who were employed as pharmacists for an average of 15.6 years. About half were pharmacy department managers and the others were staff pharmacists. The survey was conducted by Paragon Research & Consulting, an independent marketing research firm specializing in the pharmaceutical and health care industry, and sponsored by Colorcon.
About Colorcon
Colorcon, Inc. is the world leader in developing advanced film-coating systems for solid dosage medications. For more than 45 years, Colorcon has assisted pharmaceutical scientists worldwide with tablet formulation, modified release film coatings, and advanced science expertise, helping them produce distinctive, patient-friendly tablets that are easy to identify and swallow. BEST(TM), the Brand Enhancement System for Tablets, is a Colorcon division that provides marketing and technical expertise enabling pharmaceutical companies to distinguish their tablets through color, shape, high-definition imprinting, special coatings, flavors, and product security identifiers. The resulting tablets are designed to improve compliance and reduce medical error, benefiting patients, pharmacists and the health care industry alike. For more information about Colorcon and BEST(TM), please visit http://www.colorcon.com/best.
Footnotes
1. "To Err Is Human: Building a Safer Health System." Institute of Medicine of the National Academies. 2000. www.iom.edu/?id=12735. Accessed 5/26/06.
2. "Consumer Information for Safe Medication Use." National Coordinating Council for Medication Error Reporting and Prevention. www.nccmerp.org/consumerInfo.html. Accessed 5/1/06.
3. E Graham-Clarke and N Langford, "All that glisters is not gold! Confusion arises from identical tablet markings." Pharmaceutical Journal, 28 August 2004;273:284. www.pjonline.com/editorial/20040828/comment/spectrum.html. Accessed 5/1/06.
4. U.S. Food and Drug Administration, Center for Drug Evaluation and Research, "Medicines and You: A Guide for Older Adults." www.fda.gov/cder/consumerinfo/medAndYouEng.htm. Accessed 4/28/06.
5. Expert Committee Meeting Summaries: Safe Medication Use Expert Committee, U.S. Pharmacopeia. October 11-12, 2004. http://www.usp.org/USPNF/meetingSummaries/2004/10-11.html. Accessed 5/3/06.