Effects of Text Enhancement on Reduction of Look-Alike Drug Name Confusion: A Systematic Review and Meta-analysis

Abstract

Background and Objectives: Drug name confusion induced by look-alike drug names represents a serious health care management problem in practice. Text enhancement by changing visual attributes of look-alike drug names has been proposed and widely applied in practice to mitigate drug name confusion. However, the effectiveness of text enhancement on reducing drug name confusion is yet to be determined. This study aimed to explore the effects of text enhancement on reduction of confusion caused by look-alike drug names through systematic review and meta-analysis. Methods: We searched 5 databases (from database inception to January 2020) for empirical studies that examined the effects of text enhancement on reduction of look-alike drug name-induced drug name confusion. The pooled outcome data were analyzed using either meta-analysis or a narrative synthesis approach. Results: From the 351 identified articles, 11 articles representing 20 individual trials were included. Five basic text enhancement methods were revealed, including Tall Man, red, boldface, contrast, and size enhancement, from which 4 Tall Man variants and 6 text enhancement combinations were derived. The meta-analysis results showed significant reduction in omission errors when using Tall Man (standardized mean difference [SMD] = −0.628, 95% confidence interval [CI]: −1.018 to −0.238, P = .002), red (SMD = −0.516, 95% CI: −1.002 to −0.030, P = .038), boldface (SMD = −1.027, 95% CI: −1.240 to −0.814, P < .001), and contrast (SMD = −0.437, 95% CI: −0.869 to −0.004, P = 0.048), as compared with lowercase. This finding was also supported in our subgroup analysis by task type for name differentiation tasks. No other significant effects of text enhancement were found for either commission errors or response time. Conclusions: Using Tall Man, red, boldface, or contrast could help reduce omission errors (ie, wrong medication selection) caused by look-alike drug names, particularly in name differentiation tasks. However, no text enhancement could shorten name search and/or differentiation time. Our findings could facilitate the understanding of the effects of text enhancement in the prevention of confusion errors caused by look-alike drug names and promote the application of text enhancement in practice.

RaDonda Vaught, medication safety, and the profession of pharmacy: Steps to improve safety and ensure justice

“…Best practices should ideally include barcoding for medication administration, intravenous (IV) preparation, and dispensing 1 ; limiting access to high alert medications 2 ; indication alerts to warn prescribers when an ordered drug is not justified by any active problem [3][4][5] ; indication-based prescribing to help ensure that the only alternatives presented during order match the intended indication (eg, hydralazine would never come as a choice where ordering a medicine for itching, only hydroxyzine) [6][7][8] ; redesigned interfaces that are less error-prone (ie, that limit fuzzy matching, require at least five letters in a search string) 9 ; guiding prescribers toward conservative ordering 10 and diagnosis 11 to reduce the exposure to harm; and text enhancement (that goes beyond mixed case lettering) to increase the legibility and discriminability of drug names. 12 This is a long list, and resources are finite. Prioritize actions with the strongest evidence (eg, barcoding) and the most impact on harm reduction (eg, focusing on high alert drugs like paralytic agents, chemotherapeutics, opioids, insulins, and anticoagulants).…”

“…The most important thing pharmacists can do is to recommit to the unending work of making drug use safer by identifying, implementing, and then widely and consistently disseminating safe medication practices. Best practices should ideally include barcoding for medication administration, intravenous (IV) preparation, and dispensing 1 ; limiting access to high alert medications 2 ; indication alerts to warn prescribers when an ordered drug is not justified by any active problem 3‐5 ; indication‐based prescribing to help ensure that the only alternatives presented during order match the intended indication (eg, hydralazine would never come as a choice where ordering a medicine for itching, only hydroxyzine) 6‐8 ; redesigned interfaces that are less error‐prone (ie, that limit fuzzy matching, require at least five letters in a search string) 9 ; guiding prescribers toward conservative ordering 10 and diagnosis 11 to reduce the exposure to harm; and text enhancement (that goes beyond mixed case lettering) to increase the legibility and discriminability of drug names 12 . This is a long list, and resources are finite.…”

Beyond mixed case lettering: reducing the risk of wrong drug errors requires a multimodal response

“…It would also be useful to understand the effects of other types of text enhancement such as bolding, italics, colour or enhanced contrast. Recent reviews and meta-analyses of experiments on text enhancement for drug names call for more rigorous study of text enhancements other than mixed case lettering 20. Outside of work on LASA errors, mixed case lettering has been argued in some psycholinguistic circles to disrupt the typical reading process.…”

“…Recent reviews and meta-analyses of experiments on text enhancement for drug names call for more rigorous study of text enhancements other than mixed case lettering. 20 Outside of work on LASA errors, mixed case lettering has been argued in some psycholinguistic circles to disrupt the typical reading process. As Lohmeyer et al note, this disruption could be part of the mechanism behind any benefits of mixed case lettering.…”