Medication errors occur frequently in outpatient health care. Poorly designed prescription drug labels are thought to contribute to the problem. Although patients should be counseled by their physicians and pharmacists on adverse effects and proper administration of medication, there is evidence that appropriate counseling is often not done. Auxiliary pamphlets can contain useful information, but might be discarded or ignored. As a consequence, patients might rely on the container label for information.
A group of researchers decided to assess the usefulness of medication container labels. Identically written prescriptions for 4 commonly used medications (atorvastatin calcium, alendronate sodium, trimethoprimsulfamethoxazole, and ibuprofen) were filled in 6 pharmacies (large chain, grocery store, and independent) in 4 large American cities. The researchers evaluated the format and content of the main container labels and any auxiliary stickers.
Eighty-five labels were evaluated; 11 ibuprofen containers were excluded, as they were over-the-counter formulations without pharmacy-printed labels. The most prominent item on 84% of the labels was the name of the pharmacy, printed in a mean font size of 13.6 points. Colour, highlighting, and boldface were generally reserved for items primarily useful to pharmacists (eg, prescription number, refill status, and quantity).
Font sizes were considerably smaller for information that might be more important to patients: medication instructions (9.3 points), medication name (8.9 points), and warning or instruction stickers (6.5 points). These sizes might be difficult for the elderly to read, even with refractive glasses. Warning stickers (eg, for common interactions, specialized instructions, or adverse effects) were inconsistently used; when used, 82% of the warning stickers were affixed sideways.
Bottom line
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The authors call for the development of an “evidence-based” prescription drug label that is easy to read and understand.
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Given the variability in the quality of medication container labeling, physicians should be very explicit in writing medication instructions on prescriptions, should counsel patients carefully, and should review medications at appointments.
Footnotes
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Source: Shrank WH, Agnew-Blais J, Choudhry NK, Wolf MS, Kesselheim AS, Avorn J, et al. The variability and quality of medication container labels. Arch Intern Med 2007;167:1760–5.
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