Package Design Affects Accuracy Recognition for Medications

Objective: Our aim was to test if highlighting and placement of substance name on medication package have the potential to reduce patient errors. Background: An unintentional overdose of medication is a large health issue that might be linked to medication package design. In two experiments, placement, background color, and the active ingredient of generic medication packages were manipulated according to best human factors guidelines to reduce causes of labeling-related patient errors. Method: In two experiments, we compared the original packaging with packages where we varied placement of the name, dose, and background of the active ingredient. Age-relevant differences and the effect of color on medication recognition error were tested. In Experiment 1, 59 volunteers (30 elderly and 29 young students), participated. In Experiment 2, 25 volunteers participated. Results: The most common error was the inability to identify that two different packages contained the same active ingredient (young, 41%, and elderly, 68%). This kind of error decreased with the redesigned packages (young, 8%, and elderly, 16%). Confusion errors related to color design were reduced by two thirds in the redesigned packages compared with original generic medications. Conclusion: Prominent placement of substance name and dose with a band of high-contrast color support recognition of the active substance in medications. Application: A simple modification including highlighting and placing the name of the active ingredient in the upper right-hand corner of the package helps users realize that two different packages can contain the same active substance, thus reducing the risk of inadvertent medication overdose.

[1]  M. Peters,et al.  Applications of mental rotation figures of the Shepard and Metzler type and description of a mental rotation stimulus library , 2008, Brain and Cognition.

[2]  S. Weiss Compliance packaging for over-the-counter drug products , 2009, Journal of Public Health.

[3]  Itiel E Dror,et al.  Older Adults Use Mental Representations That Reduce Cognitive Load: Mental Rotation Utilizes Holistic Representations and Processing , 2005, Experimental aging research.

[4]  José Joaquín Mira,et al.  A systematic review of patient medication error on self-administering medication at home , 2015, Expert opinion on drug safety.

[5]  P John Clarkson,et al.  Designing packaging to support the safe use of medicines at home. , 2010, Applied ergonomics.

[6]  A. Granås,et al.  Patients’ attitudes towards and experiences of generic drug substitution in Norway , 2006, Pharmacy World and Science.

[7]  Alan C. Bovik,et al.  Visual search: structure from noise , 2002, ETRA.

[8]  D. Metzler,et al.  Mental rotation: effects of dimensionality of objects and type of task. , 1988, Journal of Experimental Psychology: Human Perception and Performance.

[9]  Richard J Holden,et al.  The patient work system: an analysis of self-care performance barriers among elderly heart failure patients and their informal caregivers. , 2015, Applied ergonomics.

[10]  L. Cooper,et al.  Mental transformations and visual comparison processes: effects of complexity and similarity. , 1976, Journal of experimental psychology. Human perception and performance.

[11]  R. Arnheim,et al.  Art and Visual Perception: A Psychology of the Creative Eye. , 1956 .

[12]  E. Toverud,et al.  Generic substitution: additional challenge for adherence in hypertensive patients? , 2009, Current medical research and opinion.

[13]  Adrienne Berman,et al.  Reducing Medication Errors Through Naming, Labeling, and Packaging , 2004, Journal of Medical Systems.

[14]  M. Wolf,et al.  To err is human: patient misinterpretations of prescription drug label instructions. , 2007, Patient education and counseling.

[15]  M. Wolf,et al.  Risk of Unintentional Overdose with Non-Prescription Acetaminophen Products , 2012, Journal of General Internal Medicine.

[16]  J. Brandt Human Factors and Ophthalmic Drug Packaging: Time for a Global Standard. , 2015, Ophthalmology.

[17]  César Fernández Peris,et al.  Use of QR and EAN-13 codes by older patients taking multiple medications for a safer use of medication , 2015, Int. J. Medical Informatics.

[18]  Anjali U. Pandit,et al.  Availability of Spanish Prescription Labels: A Multi-State Pharmacy Survey , 2009, Medical care.

[19]  E. Glisky Changes in Cognitive Function in Human Aging , 2007 .

[20]  Benard P Dreyer,et al.  Parents' medication administration errors: role of dosing instruments and health literacy. , 2010, Archives of pediatrics & adolescent medicine.

[21]  Michael R. Cohen Medication errors. , 2014, Nursing.

[22]  Jamie L. Estock,et al.  Label Design Affects Medication Safety in an Operating Room Crisis: A Controlled Simulation Study , 2015, Journal of patient safety.

[23]  F. Federico,et al.  Preventing medication errors. , 2000, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[24]  J W Kenagy,et al.  Naming, labeling, and packaging of pharmaceuticals. , 2001, American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists.

[25]  Alastair G. Gale,et al.  Labeling of Medicines and Patient Safety: Evaluating Methods of Reducing Drug Name Confusion , 2006, Hum. Factors.

[26]  Allison Y Strochlic,et al.  Applying human factors to develop an improved package design for (Rx) medication drug labels in a pharmacy setting. , 2015, Journal of safety research.

[27]  Woodrow Barfield,et al.  The Mental Rotation and Perceived Realism of Computer-Generated Three-Dimensional Images , 1988, Int. J. Man Mach. Stud..

[28]  Leonie Kohl,et al.  Mental Images And Their Transformations , 2016 .

[29]  P. Noyce,et al.  Hospital Admissions Associated with Adverse Drug Reactions: A Systematic Review of Prospective Observational Studies , 2008, The Annals of pharmacotherapy.

[30]  J. Prins Directive 2003/98/EC of the European Parliament and of the Council , 2006 .

[31]  E. Toverud,et al.  Special challenges for drug adherence following generic substitution in Pakistani immigrants living in Norway , 2010, European Journal of Clinical Pharmacology.

[32]  P. Baltes,et al.  Emergence of a powerful connection between sensory and cognitive functions across the adult life span: a new window to the study of cognitive aging? , 1997, Psychology and aging.

[33]  Y. Aitsiselmi,et al.  Using mental rotation to evaluate the benefits of stereoscopic displays , 2009, Electronic Imaging.

[34]  G. D. De Meyer,et al.  Consumer choice between common generic and brand medicines in a country with a small generic market. , 2015, Journal of managed care & specialty pharmacy.

[35]  M. Sheelagh T. Carpendale,et al.  Shallow-depth 3d interaction: design and evaluation of one-, two- and three-touch techniques , 2007, CHI.