When patients misunderstand prescription labels on med bottles: what can be done about it

(NOTE: you may have to copy and paste some of below links to your browser, as a few of them seemed "stubborn" about linking)

In the world of medicine they're as normal and as common as anything: those little labels glued on to the pill bottles we regularly get at our pharmacies when we pick up our prescriptions.

While a few years old, here's an article that discusses the clarity (or lack of it) of some of those labels:

https://www.sciencedaily.com/releases/2006/11/061129093308.htm

From it:

"Shake well," a patient apparently read out loud to the pharmacist from his prescription bottle label. "Does that mean I shake myself?"

"Many people still don't fully understand the seemingly simple label instructions on their prescription medication ... nearly half of the patients in the study misinterpreted at least one or more out of the five prescription labels they were shown. Patients with low literacy made the most mistakes and frequently were unable to grasp four out of five label instructions. But even people with a high-school education and higher had problems."

"It was surprising how prevalent mistakes were regardless of an individual's literacy level. Just being able to read the label doesn't mean you'll be able to interpret it."

Wolf (the researcher) believes the main culprit is awkward wording. "Why are we not phrasing things properly on bottles?" he asked.

" ... the Institute of Medicine reported 1.5 million patients are injured each year by medication errors, of which more than one-third occur at home."

"The most common mistake made by patients in the study was misinterpreting dosage instructions (a tablespoon versus a teaspoon) followed by misunderstanding the dose frequency."

"The more numbers included in the dosage, the more likely patients in the study got it wrong. The hardest label to understand: Take 1 teaspoon 3 times a day for 7 days. It's possible people read this quickly because they perceive it as simple. They get the numbers flipped. They confuse and misread them."

"Patients reading at a sixth-grade level or below could read it back. But if you ask them what it means to take two tablets twice daily, only one-third of the patients with limited literacy skills got that correct."

(There is even an entire discussion devoted to interpreting the meaning of "take two tablets twice daily") here:

https://hellopharmacist.com/questions/two-tablets-at-the-same-time-or-one-twice-daily

Also a little old, but per the AARP, some ways to remedy some of these issues:

https://www.aarp.org/health/healthy-living/info-2018/prescription-pill-bottle-drug-safety.html

This article talks about such things as vague instructions, tiny print, and scheduling confusion on when to take meds. Some solutions it offers are: label redesign to improve clarity, labels in other languages for non-English speakers, and larger text.

Another innovation, now currently available, is "talking labels": audio instructions for people with vision impairment. Here's something about the CVS Pharmacy version of that:

https://www.cvshealth.com/news/innovation/talking-prescription-bottles-can-make-life-easier.html

And details from the CVS website itself on how to get it:

https://www.cvs.com/content/pharmacy/spoken-rx

So the work goes on to make pharmacy bottle labels more effective.

BTW, for anyone interested, here is what the FDA has to say, the official word, about the labelling of medicine bottles ("Labeling Requirements for Prescription Drugs and/or Insulin," per "Code of Federal Regulations Title 21")

https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/cfrsearch.cfm?cfrpart=201&showfr=1&subpartnode=21:4.0.1.1.2.2#:~:text=prescription%20drug%20labeling%20described%20in%20%c2%a7%20201.100%20%28d%29,possible%20on%20data%20derived%20from%20human%20experience.%20

I tried to read it, getting only about a screen into it before my eyes started to glaze over.

Anyone else see the wonderful irony here? That the federal guidance now in place for composing clear, effective text for medicine labels is itself so verbose, bloated, and intimidating? Click on the above link, read a bit of it, and see for yourself.

I also found reference to

" ... the nonprofit advisory group U.S. Pharmacopeia (USP), which sets recommendations for prescription labeling. Each state has its own specific requirements, which focus mostly on what the labels must state but not on the clarity of that content."

But for federal guidance, there is

https://www.usp.org/sites/default/files/usp/document/health-quality-safety/commentary-for-general-chapter-17-prescription-container.pdf

which goes into exquisite detail on how to compose for the general public an easy to read and understand prescription bottle label. Guidelines such as "simplify language," "give explicit instructions," "include purpose of use," and "limit auxiliary information" are covered, with short commentary on each.

And to do something personally about what one considers to be a particularly unhelpful pill bottle label? Report complaints to the FDA:

https://www.fda.gov/consumers/consumer-updates/fda-101-how-use-consumer-complaint-system-and-medwatch

(when there, see: "Problems related to prescription or over-the-counter medications").

WHEW! So many rules and regulations for writing and getting instructions on to our pill bottles!

But maybe that's not such a bad thing, considering the harm that poorly written instructions might do.

But to end on a lighter note, of course none of this discussion is to include any of the intentionally humorous "labels" that some see fit to post on the web for fun. Examples:

https://www.bing.com/images/search?view=detailv2&ccid=1d%2b%2bo5kp&id=c512f9860657e24e3f5aef144b0a391675a51af9&thid=oip.1d--o5kpswqtqwhqhklrdqhagw&mediaurl=https%3a%2F%2Fwww.giftsbysimonemadeit.com%2Fwp-content%2Fuploads%2F2019%2F10%2Fold-age-prescription-gin-bottle-labels-printable-template.png&cdnurl=https%3a%2F%2Fth.bing.com%2Fth%2Fid%2Fr.d5dfbe3b9929b3042da961d01ca96b0d%3frik%3D%252brqldry5cksu7w%26pid%3Dimgraw%26r%3D0&exph=1115&expw=1300&q=confusing+medicine+bottle+labels++&simid=608019768768992425&form=irprst&ck=2fec49a3c536f229175930b258d583c4&selectedindex=0&idpp=overlayview&ajaxhist=0&ajaxserp=0

and

https://www.bing.com/images/search?view=detailv2&ccid=vxbjecse&id=c6abf470ba0f8e616979e09dc0e98af7cd419b2b&thid=oip.vxbjecse47lktp5soulshwhaf1&mediaurl=https%3a%2F%2Fwww.giftsbysimonemadeit.com%2Fwp-content%2Fuploads%2F2019%2F10%2Fwalgreens-prescription-christmas-chill-pills-jar-labels-candy-cane.png&cdnurl=https%3a%2F%2Fth.bing.com%2Fth%2Fid%2Fr.5576e311c484e3b9644cfe523ae9521f%3frik%3Dk5tbzfek6ccd4a%26pid%3Dimgraw%26r%3D0&exph=1025&expw=1300&q=confusing+medicine+bottle+labels++&simid=608044000959621244&form=irprst&ck=c34c135524dc446f95da4bb4e1a3f6a0&selectedindex=7&ajaxhist=0&ajaxserp=0

and

https://www.bing.com/images/search?view=detailv2&ccid=ig%2ba5gfi&id=2ad843d6c4cb0fa458141fdf82545a0e3235b012&thid=oip.ig-a5gfit1ht88bd_lkojahadt&mediaurl=https%3a%2F%2Fi.pinimg.com%2F736x%2F81%2F70%2Fd8%2F8170d8f73c5094e6049cd76a29cc5e11--appreciation-gifts-employee-appreciation.jpg&cdnurl=https%3a%2F%2Fth.bing.com%2Fth%2Fid%2Fr.886f80e461624f51d3f3c043fcb28e24%3frik%3Dera1mg5avilfhw%26pid%3Dimgraw%26r%3D0&exph=368&expw=736&q=confusing+medicine+bottle+labels++&simid=608049051836224828&form=irprst&ck=4296d724ce8ed42bda8476ff0a5f6a65&selectedindex=16&ajaxhist=0&ajaxserp=0

Nope, these are not the kinds of medicine bottle instructional labels we are talking about.

Although I suppose it could be argued that the immediately above three "prescriptions" might in some circumstances be just as effective as more traditional medications.

I take my prescriptions, take a sharpie, and immediately write on them my interpretation of them. Big colored letters. Otherwise lord knows…