WEST POINT, Pa., July 30, 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 survey of 150 pharmacists in the United States. 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 in U.S. hospitals alone, and tens of thousands more in outpatient facilities (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 taken, 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 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.
"The survey confirms the importance of clear identification of tablets for both patients and pharmacists," said F. Rick Kettinger, Managing Director, Brand Enhancement Services at Colorcon, which helps companies worldwide develop distinctive tablets that are easier to identify and swallow, and has an office in Vema, India. "As the number of discrete solid dose tablet offerings continues to grow, differentiation is becoming more difficult for pharmacists, nurses, physicians, patients and caregivers. Errors in dispensing and in patient compliance 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.
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.
Medication Error in India
The issue of medication error in India is extremely complex. A choice needs to be made, for example, not only from 11 ACE inhibitors, but also from 11 or more brands of each ACE inhibitor (4). Adverse drug reactions (ADRs) are the fourth most common cause of death in the U.S., accounting for more than 100,000 deaths per year. For India, the extrapolated figures would be 400,000 deaths due to ADRs and 720,000 adverse events per year. In addition, ADRs account for 45% of all adverse drug events (ADEs). Although a proper reporting of medication errors in the hospital is not available, of all ADE-related visits to the emergency department, 52% (and of ADE-related admissions, 55%) were considered preventable (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, or call the Colorcon office in Vema, India at 91-832-288-3434.
Footnotes
1. T Nordenberg, "Make No Mistake: Medical Errors Can Be Deadly
Serious." FDA Consumer Magazine, September-October 2000.
www.fda.gov/fdac/features/2000/500_err.html. Accessed 4/28/06.
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. Mehta S, Gogtay NJ. "From the pen to the patient: Minimising
medication errors." J Postgrad Med 2005, 51:3-4. Accessed 5/19/06.
5. Bhatt A. "Medication errors: Malpractice implications &
prevention." Express Healthcare Management