RT Journal Article
SR Electronic
T1 Effects of tall man lettering on the visual behaviour of critical care nurses while identifying syringe drug labels: a randomised in situ simulation
JF BMJ Quality & Safety
JO BMJ Qual Saf
FD BMJ Publishing Group Ltd
SP 26
OP 33
DO 10.1136/bmjqs-2021-014438
VO 32
IS 1
A1 Quentin Lohmeyer
A1 Cornel Schiess
A1 Pedro David Wendel Garcia
A1 Heidi Petry
A1 Eric Strauch
A1 Andreas Dietsche
A1 Reto A. Schuepbach
A1 Philipp K. Buehler
A1 Daniel A. Hofmaenner
YR 2023
UL http://qualitysafety.bmj.com/content/32/1/26.abstract
AB Background Patients in intensive care units are prone to the occurrence of medication errors. Look-alike, sound-alike drugs with similar drug names can lead to medication errors and therefore endanger patient safety. Capitalisation of distinct text parts in drug names might facilitate differentiation of medication labels. The aim of this study was to test whether the use of such ‘tall man’ lettering (TML) reduces the error rate and to examine effects on the visual attention of critical care nurses while identifying syringe labels.Methods This was a prospective, randomised in situ simulation conducted at the University Hospital Zurich, Zurich, Switzerland. Under observation by eye tracking, 30 nurses were given 10 successive tasks involving the presentation of a drug name and its selection from a dedicated set of 10 labelled syringes that included look-alike and sound-alike drug names, half of which had TML-coded labels.Error rate as well as dwell time, fixation count, fixation duration and revisits were analysed using a linear mixed-effects model analysis to compare TML-coded with non-TML-coded labels.Results TML coding of syringe labels led to a significant decrease in the error rate (from 5.3% (8 of 150 in non-TML-coded sets) to 0.7% (1 of 150 in TML-coded sets), p<0.05). Eye tracking further showed that TML affects visual attention, resulting in longer dwell time (p<0.01), more and longer fixations (p<0.05 and p<0.01, respectively) on the drug name as well as more frequent revisits (p<0.01) compared with non-TML-coded labels. Detailed analysis revealed that these effects were stronger for labels using TML in the mid-to-end position of the drug name.Conclusions TML in drug names changes visual attention while identifying syringe labels and supports critical care nurses in preventing medication errors.Data are available upon reasonable request. The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.