title: Cognitive tests predict real-world errors: the relationship between drug name confusion rates in laboratory-based memory and perception tests and corresponding error rates in large pharmacy chains.
abstract: Drug name confusion is a common type of medication error and a persistent threat to patient safety. In the USA, roughly one per thousand prescriptions results in the wrong drug being filled, and most of these errors involve drug names that look or sound alike. Prior to approval, drug names undergo a variety of tests to assess their potential for confusability, but none of these preapproval tests has been shown to predict real-world error rates.
  
  
  
  We conducted a study to assess the association between error rates in laboratory-based tests of drug name memory and perception and real-world drug name confusion error rates.
  
  
  
  Eighty participants, comprising doctors, nurses, pharmacists, technicians and lay people, completed a battery of laboratory tests assessing visual perception, auditory perception and short-term memory of look-alike and sound-alike drug name pairs (eg, hydroxyzine/hydralazine).
  
  
  
  Laboratory test error rates (and other metrics) significantly predicted real-world error rates obtained from a large, outpatient pharmacy chain, with the best-fitting model accounting for 37% of the variance in real-world error rates. Cross-validation analyses confirmed these results, showing that the laboratory tests also predicted errors from a second pharmacy chain, with 45% of the variance being explained by the laboratory test data.
  
  
  
  Across two distinct pharmacy chains, there is a strong and significant association between drug name confusion error rates observed in the real world and those observed in laboratory-based tests of memory and perception. Regulators and drug companies seeking a validated preapproval method for identifying confusing drug names ought to consider using these simple tests. By using a standard battery of memory and perception tests, it should be possible to reduce the number of confusing look-alike and sound-alike drug name pairs that reach the market, which will help protect patients from potentially harmful medication errors.
authors.affiliation: Center for Communication and Health, Department of Communication Studies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Scott R
authors.initials: SR
authors.lastname: Schroeder
authors.affiliation: Department of Psychology, Northwestern University, Evanston, Illinois, USA.
authors.forename: Meghan M
authors.initials: MM
authors.lastname: Salomon
authors.affiliation: Department of Medicine, University of Illinois, Chicago, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Galanter
authors.affiliation: Department of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.affiliation: Institute for Safe Medication Practices, Horsham, Pennsylvania, USA.
authors.forename: Allen J
authors.initials: AJ
authors.lastname: Vaida
authors.affiliation: Institute for Safe Medication Practices, Horsham, Pennsylvania, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Gaunt
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bryson
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois, USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Rash
authors.affiliation: Department of Medicine, University of Illinois, Chicago, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Falck
authors.affiliation: Center for Communication and Health, Department of Communication Studies, Northwestern University, Chicago, Illinois, USA.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Lambert
mesh_terms: D000328:Adult; D001307:Auditory Perception; D003071:Cognition; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008508:Medication Errors / Q000517:prevention & control / Q000523:psychology*; D008568:Memory; D008875:Middle Aged; D009483:Neuropsychological Tests; D010465:Perception; D004364:Pharmaceutical Preparations; D010594:Pharmacies; D010700:Phonetics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D009626:Terminology as Topic; D014481:United States; D055815:Young Adult
chemical_list: D004364:Pharmaceutical Preparations
keywords: Human error; Human factors; Medication safety; Patient safety