Safety and efficiency of a new generic package labelling: a before and after study in a simulated setting

Abstract

BackgroundMedication errors are frequent and may cause harm to patients and increase healthcare expenses.AimTo explore whether a new labelling influences time and errors when preparing medications in accordance with medication charts in an experimental setting.MethodWe carried out an uncontrolled before and after study with 3 months inbetween experiments. Phase I used original labelling and phase II used new generic labelling. We set up an experimental medicine room, simulating a real-life setting. Twenty-five nurses and ten pharmacy technicians participated in the study. We asked them to prepare medications in accordance with medication charts, place packages on a desk and document the package prepared. We timed the operation. Participants were asked to prepare medications in accordance with as many charts as possible within 30 min.ResultsNurses prepared significantly more medication charts with the generic labelling compared with the original 3.3 versus 2.6 (p=0.009). Mean time per medication chart was significantly lower with the generic labelling 6.9 min/chart versus 8.5 min/chart (p<0.001). Pharmacy technicians were significantly faster than the nurses in both phase I (6.8 min/chart vs 9.5 min/chart; p<0.001) and phase II (6.1 min/chart vs 7.2 min/chart; p=0.013). The number of errors was low and not significantly different between the two labellings, with errors affecting 9.1% of charts in phase I versus 6.5% in phase II (p=0.5).ConclusionsA new labelling of medication packages with prominent placement of the active substance(s) and strength(s) in the front of the medication package may reduce time for nurses when preparing medications, without increasing medication errors.

Fixed-dose combination antihypertensives and risk of medication errors

“…In addition, increased generic prescribing and dispensing (ie, using INN) may also reduce medication errors. In a simulated before and after study of generic labelling of medications, FDCs were one of just two circumstances where errors decreased 28. When patients and doctors are considering an FDC, it is important to assess the potential risks and benefits.…”

Using clinical simulation to study how to improve quality and safety in healthcare

“…Quasi-experimental studies : uncontrolled study of a new drug packaging system (box 4),92 uncontrolled evaluation of a paediatric resuscitation training package,93 non-randomised controlled study of an intervention to improve the management of distractions and interruptions during ward rounds94…”

“…Medication errors are a leading cause of adverse events in hospitals. Garcia et al 92 studied the impact of a new labelling system using a simulated medicine room. For 30 min, each participant was handed a new medication chart once he/she had completed preparation for the previous one.…”

Challenges in making standardisation work in healthcare: lessons from a qualitative interview study of a line-labelling policy in a UK region

“…Prototyping, testing and evaluating solutions in short refinement cycles are core aspects of a design thinking approach 31 32. When confronting potential users with prospective designs, they should be presented with an artefact with which they can interact, and observe how they do it—for example, through clinical simulation 33 34. Observation is important because participants may estimate one solution to be better in a survey, when actual experimentation shows otherwise 35.…”