Safer dispensing labels for prescription medicines

Abstract

The standard way in which directions are represented on dispensing labels can be misinterpreted. Errors in interpreting instructions are more common in people with low health literacy and when the timing of administration is not specified. Improving written communication on prescriptions and dispensing labels can reduce medication errors. There is an emerging international consensus on best-practice communication on dispensing labels. Medication errors In a US trial, 395 participants were given five common prescription medicines with a dispensing label and asked how they would take the medicine. 4 The medicines and their instructions included: • amoxicillin, 'take one teaspoonful by mouth three times a day' • furosemide (frusemide), 'take one tablet in the morning and one at 5 pm' • guaifenesin, 'take two tablets by mouth twice daily'. Almost half of the participants misunderstood one or more of the dispensing labels. Errors were more common in those with low health literacy (reading ability of sixth grade or less) and when less explicit directions were provided. For instance, 41.3% of participants with low health literacy misunderstood the directions for amoxicillin, whereas only 17.3% of the participants with low health literacy misunderstood the more explicit directions for furosemide (frusemide). A separate analysis of the same study showed that errors in relation to the amoxicillin directions were a mixture of misunderstanding the measurement of the dose and the timing of administration. For example 'take one teaspoonful by mouth three times a day' was misunderstood as 'take three teaspoons daily' or 'take three tablespoons every day'. 6 Having someone accurately describe the dose of a medicine does not mean that they will take the correct dose. Participants were asked how many guaifenesin tablets they would take each day when instructed to 'take two tablets by mouth twice daily'. 4 Some participants who could appropriately describe the recommended dose still made an error when asked to demonstrate how many tablets they would