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Journal Article

Citation

Endestad T, Wortinger LA, Madsen S, Hortemo S. Hum. Factors 2016; 58(8): 1206-1216.

Affiliation

Norwegian Medicines Agency, Oslo, Norway.

Copyright

(Copyright © 2016, Human Factors and Ergonomics Society, Publisher SAGE Publishing)

DOI

10.1177/0018720816664824

PMID

27591209

Abstract

OBJECTIVE: Our aim was to test if highlighting and placement of substance name on medication package have the potential to reduce patient errors.

BACKGROUND: An unintentional overdose of medication is a large health issue that might be linked to medication package design. In two experiments, placement, background color, and the active ingredient of generic medication packages were manipulated according to best human factors guidelines to reduce causes of labeling-related patient errors.

METHOD: In two experiments, we compared the original packaging with packages where we varied placement of the name, dose, and background of the active ingredient. Age-relevant differences and the effect of color on medication recognition error were tested. In Experiment 1, 59 volunteers (30 elderly and 29 young students), participated. In Experiment 2, 25 volunteers participated.

RESULTS: The most common error was the inability to identify that two different packages contained the same active ingredient (young, 41%, and elderly, 68%). This kind of error decreased with the redesigned packages (young, 8%, and elderly, 16%). Confusion errors related to color design were reduced by two thirds in the redesigned packages compared with original generic medications.

CONCLUSION: Prominent placement of substance name and dose with a band of high-contrast color support recognition of the active substance in medications. APPLICATION: A simple modification including highlighting and placing the name of the active ingredient in the upper right-hand corner of the package helps users realize that two different packages can contain the same active substance, thus reducing the risk of inadvertent medication overdose.

© 2016, Human Factors and Ergonomics Society.


Language: en

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