Ability of Practitioners to Identify Solid Oral Dosage Tablets
Ability of Practitioners to Identify Solid Oral Dosage Tablets
Purpose: Physicians' and pharmacists' ability to correctly identify three commonly used oral dosage forms was assessed.
Methods: A list of physicians and pharmacists was obtained from two urban teaching hospitals. A total of 100 pharmacists and physicians were randomly selected and their ability to correctly identify three commonly used tablets was tested. Participants were also asked about their experiences and views on current resources and alternatives for identifying oral dosage forms. Tablet-identification exercises were performed by physicians and pharmacists in their usual practice settings. Participants could consult the resources usually available to them for the identification of unknown medications.
Results: A total of 300 observations were made in the tablet-identification exercise (100 participants, three tablets per participant). The tablet was correctly identified in 190 of the observations (63%). The brand-name tablet, the generic tablet, and the nonprescription generic tablet were correctly identified in 78%, 64%, and 48% of the observations, respectively. Only 18 physicians (36%) and 24 pharmacists (48%) correctly identified all three tablets, whereas 10 physicians (20%) and 5 pharmacists (10%) could not correctly identify any of the tablets. The mean time required to identify a tablet was 3.65 minutes. Pharmacists most often used electronic resources (52%), while physicians relied on print resources. Overall, 77% expressed dissatisfaction with the current system and 91% favored a universal imprint coding system for oral dosage forms.
Conclusion: Physicians and pharmacists failed to correctly identify three commonly prescribed tablets more than a third of the time. The brand-name tablet was correctly identified more often than were the prescription generic and nonprescription generic products.
To safely use medications, health professionals and patients need easy-to-use and reliable methods to identify tablets and capsules. For decades, when confronted with an elderly patient with a handkerchief or medication organizer full of unknown tablets or a patient who has overdosed, practitioners have used various resources, including color photographs in the Physicians' Desk Reference (PDR) and, more recently, a variety of online resources, to identify the drugs. At times, they contact poison control centers, which receive more than 500,000 calls annually solely for medication identification.
One factor that complicates easy and accurate identification of a tablet or a capsule is that each manufacturer of solid oral dosage forms marketed in the United States assigns its own identifying codes and symbols, in conformance with Food and Drug Administration requirements. As a result, there is no standardized coding system to uniquely identify each tablet or capsule, nor is there a freely accessible, definitive database for practitioners or patients to use to readily identify tablets or capsules.
Frustrations with the existing resources for the identification of solid oral dosage forms in the early 1960s led the Journal of the American Medical Association to publish a special issue entirely dedicated to the identification of more than 5000 marketed tablets and capsules that featured color photographs. However, one study found that even when using this resource, clinicians could correctly identify only 30% of tablets and required an average of 15 minutes to identify a tablet. While the number of drugs has multiplied in the past four decades, so have the resources available for drug identification. In recent years, drug monographs and online drug information resources have become available, although it is not clear how accessible practitioners find these resources or how efficient they are in using them.
Proposals for a more standardized and easier-to-use tablet imprint-coding system that does not rely on shape, size, or color have been suggested but have been met with resistance from the pharmaceutical manufacturers. The pharmaceutical industry has argued that the problems cited with the current system are not compelling enough to justify the cost of implementing a more standardized system.
To further explore this issue, we conducted a study to determine physicians' and pharmacists' ability to identify tablets using all resources available to them in their own practice settings. Our study consisted of two parts: (1) a medication identification exercise and (2) a survey of participants' past experiences with medication identification and their perceptions of current resources and the usability of the existing identification system.
Purpose: Physicians' and pharmacists' ability to correctly identify three commonly used oral dosage forms was assessed.
Methods: A list of physicians and pharmacists was obtained from two urban teaching hospitals. A total of 100 pharmacists and physicians were randomly selected and their ability to correctly identify three commonly used tablets was tested. Participants were also asked about their experiences and views on current resources and alternatives for identifying oral dosage forms. Tablet-identification exercises were performed by physicians and pharmacists in their usual practice settings. Participants could consult the resources usually available to them for the identification of unknown medications.
Results: A total of 300 observations were made in the tablet-identification exercise (100 participants, three tablets per participant). The tablet was correctly identified in 190 of the observations (63%). The brand-name tablet, the generic tablet, and the nonprescription generic tablet were correctly identified in 78%, 64%, and 48% of the observations, respectively. Only 18 physicians (36%) and 24 pharmacists (48%) correctly identified all three tablets, whereas 10 physicians (20%) and 5 pharmacists (10%) could not correctly identify any of the tablets. The mean time required to identify a tablet was 3.65 minutes. Pharmacists most often used electronic resources (52%), while physicians relied on print resources. Overall, 77% expressed dissatisfaction with the current system and 91% favored a universal imprint coding system for oral dosage forms.
Conclusion: Physicians and pharmacists failed to correctly identify three commonly prescribed tablets more than a third of the time. The brand-name tablet was correctly identified more often than were the prescription generic and nonprescription generic products.
To safely use medications, health professionals and patients need easy-to-use and reliable methods to identify tablets and capsules. For decades, when confronted with an elderly patient with a handkerchief or medication organizer full of unknown tablets or a patient who has overdosed, practitioners have used various resources, including color photographs in the Physicians' Desk Reference (PDR) and, more recently, a variety of online resources, to identify the drugs. At times, they contact poison control centers, which receive more than 500,000 calls annually solely for medication identification.
One factor that complicates easy and accurate identification of a tablet or a capsule is that each manufacturer of solid oral dosage forms marketed in the United States assigns its own identifying codes and symbols, in conformance with Food and Drug Administration requirements. As a result, there is no standardized coding system to uniquely identify each tablet or capsule, nor is there a freely accessible, definitive database for practitioners or patients to use to readily identify tablets or capsules.
Frustrations with the existing resources for the identification of solid oral dosage forms in the early 1960s led the Journal of the American Medical Association to publish a special issue entirely dedicated to the identification of more than 5000 marketed tablets and capsules that featured color photographs. However, one study found that even when using this resource, clinicians could correctly identify only 30% of tablets and required an average of 15 minutes to identify a tablet. While the number of drugs has multiplied in the past four decades, so have the resources available for drug identification. In recent years, drug monographs and online drug information resources have become available, although it is not clear how accessible practitioners find these resources or how efficient they are in using them.
Proposals for a more standardized and easier-to-use tablet imprint-coding system that does not rely on shape, size, or color have been suggested but have been met with resistance from the pharmaceutical manufacturers. The pharmaceutical industry has argued that the problems cited with the current system are not compelling enough to justify the cost of implementing a more standardized system.
To further explore this issue, we conducted a study to determine physicians' and pharmacists' ability to identify tablets using all resources available to them in their own practice settings. Our study consisted of two parts: (1) a medication identification exercise and (2) a survey of participants' past experiences with medication identification and their perceptions of current resources and the usability of the existing identification system.