Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists’ perceptions

Abstract

Background:Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used.Objective:To identify potential areas to improve the existing labels used for pediatric liquid medications.Methods:This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach.Results:Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions.Conclusion:This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.

Patient counselling service with the use of pictograms as the example of pharmacist intervention to improving compliance and medicine safety

“…Similarly, a study from Malaysia proved the positive role of pictograms in improving the quality of use of oral liquid medicines. Another study suggests that pictograms significantly increased dosing accuracy [ 25 ]. The results of a recently published analysis of 771 studies aiming to improve therapeutic adherence showed that healthcare professionals should focus more on behavioral interventions, especially those based on the development of drug use habits, than on cognitive strategies to change the knowledge and beliefs of patients [ 26 ].…”

Effectiveness of color and picture labeling in improving the knowledge on topical medications among patients with psoriasis: A randomized controlled trial

“…[ 2 3 4 14 ] Usually adherence to treatment is poorer in chronic diseases such as psoriasis due to various factors including difficulty in applying the topical medication, social factors, and treatment-related factors such as satisfaction with the treatment and complexity of the treatment protocols. [ 2 3 4 9 , 15 ] The use of easy-to-understand labels may help patients to understand the medications more easily, and hence may reduce the counseling time spent by pharmacists during dispensing. Furthermore, in a multiethnic population such as us, language and comprehensibility is one of the restricting factors for health-care providers to deliver the information.…”

“…Furthermore, in a multiethnic population such as us, language and comprehensibility is one of the restricting factors for health-care providers to deliver the information. [ 15 ] Therefore, labeling aids such as color and picture are helpful to assist the tasks of health-care personnel and patient comprehension.…”

Influences of pictogram-based instructions in paediatric drug labelling on dosing accuracy among caregivers: a pilot study from Malaysia

“…The control group received their liquid medications along with a text‐only label generated by the e‐Hospital Information System (e‐His), which has the dose expressed in millilitres (ml) . Instead, a new label, which incorporated an image of measuring scale of a 10‐ml syringe to illustrate volume to measure, was provided to the intervention group (Figure ).…”