title: Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists' perceptions.
abstract: BACKGROUND
  Inadequacies of drug labeling have been frequently reported among Malaysian healthcare institutes, in which the Hospital Information System (HIS) is used.
  
  
  OBJECTIVE
  To identify potential areas to improve the existing labels used for pediatric liquid medications.
  
  
  METHODS
  This study was qualitative in nature, whereby focus group discussions (FGDs), face-to-face interviews (FTFIs), and onsite observation were used for data collection. Pharmacists stationed at three units (outpatient, inpatient and clinical pharmacy) of a tertiary hospital were targeted. Both FGDs and FTFIs were facilitated using a semi-structured interview guide, video-recorded and transcribed verbatim. All transcripts were thematically analyzed using content analysis approach.
  
  
  RESULTS
  Thirteen pharmacists participated in FGDs, while five were approached for FTFIs. Data analysis resulted in four major themes: format of labels, presentation of medication instructions, insufficiency of information, and the need for external aids and education. Participants unanimously agreed on the need for enlarging font sizes of key information. Suggestions were made to use more specific instructions for administration times and pictograms to illustrate important directions. The absence of information about storage, stability and handling of liquid medications was also highlighted. While discussion mainly focused on improving drug labeling, participants consistently stressed the need for an instruction sheet and pharmacist-based, one-to-one education regarding medication instructions.
  
  
  CONCLUSIONS
  This study provides important insights into critical shortcomings in current labeling practice, underlying the need for developing a new label that incorporates a new format, additional information and pictograms for pediatric liquid medications.
authors.affiliation: Pharmacy Department, Sultanah Bahiyah Hospital. Kedah ( Malaysia ). huankeat123@yahoo.com.
authors.forename: Huan-Keat
authors.identifier: 0000-0001-6710-7257
authors.initials: HK
authors.lastname: Chan
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ). azmihassali@gmail.com.
authors.forename: Mohamed A
authors.identifier: 0000-0001-8269-885X
authors.initials: MA
authors.lastname: Hassali
authors.affiliation: Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia . Penang ( Malaysia ). chingjou83@gmail.com.
authors.forename: Ching-Jou
authors.identifier: 0000-0002-6026-1208
authors.initials: CJ
authors.lastname: Lim
authors.affiliation: Faculty of Pharmacy and Health Sciences, University of Baluchistan . Quetta ( Pakistan ). fahaduob@gmail.com.
authors.forename: Fahad
authors.identifier: 0000-0001-8100-8992
authors.initials: F
authors.lastname: Saleem
authors.affiliation: Pharmacy Department, Sultanah Bahiyah Hospital. Kedah ( Malaysia ). ila80@yahoo.com.
authors.forename: Norazila A
authors.identifier: 0000-0002-6350-7381
authors.initials: NA
authors.lastname: Ghani
keywords: Child; Drug labeling; Hospital; Hospital Information Systems; Malaysia; Medication Errors; Pharmacy Service