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    Systematic derivation of an Australian standard for Tall Man lettering to distinguish similar drug names

    227462_227462.pdf (704.9Kb)
    Access Status
    Open access
    Authors
    Emmerton, Lynne
    Rizk, M.
    Bedford, G.
    Lalor, D.
    Date
    2015
    Type
    Journal Article
    
    Metadata
    Show full item record
    Citation
    Emmerton, L. and Rizk, M. and Bedford, G. and Lalor, D. 2015. Systematic derivation of an Australian standard for Tall Man lettering to distinguish similar drug names. Journal of Evaluation in Clinical Practice. 21 (1): pp. 85-90.
    Source Title
    Journal of Evaluation in Clinical Practice
    DOI
    10.1111/jep.12247
    ISSN
    1356-1294
    School
    School of Pharmacy
    Remarks

    This is the peer reviewed version of the article cited above, which has been published in final form at http://doi.org/10.1111/jep.12247. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving at http://olabout.wiley.com/WileyCDA/Section/id-820227.html#terms

    URI
    http://hdl.handle.net/20.500.11937/32153
    Collection
    • Curtin Research Publications
    Abstract

    Rationale, aims and objectives - Confusion between similar drug names can cause harmful medication errors. Similar drug names can be visually differentiated using a typographical technique known as Tall Man lettering. While international conventions exist to derive Tall Man representation for drug names, there has been no national standard developed in Australia. This paper describes the derivation of a risk-based, standardized approach for use of Tall Man lettering in Australia, and known as National Tall Man Lettering. Method - A three-stage approach was applied. An Australian list of similar drug names was systematically compiled from the literature and clinical error reports. Secondly, drug name pairs were prioritized using a risk matrix based on the likelihood of name confusion (a four-component score) vs. consensus ratings of the potential severity of the confusion by 31 expert reviewers. The mid-type Tall Man convention was then applied to derive the typography for the highest priority drug pair names. Results - Of 250 pairs of confusable Australian drug names, comprising 341 discrete names, 35 pairs were identified by the matrix as an ‘extreme’ risk if confused. The mid-type Tall Man convention was successfully applied to the majority of the prioritized drugs; some adaption of the convention was required. Conclusion - This systematic process for identification of confusable drug names and associated risk, followed by application of a convention for Tall Man lettering, has produced a standard now endorsed for use in clinical settings in Australia. Periodic updating is recommended to accommodate new drug names and error reports.

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