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Original research
Psycholinguistic tests predict real-world drug name confusion error rates: a cross-sectional experimental study
  1. Bruce L Lambert1,
  2. Scott Ryan Schroeder2,
  3. William L. Galanter3,
  4. Gordon D. Schiff4,5,
  5. Allen J Vaida6,
  6. Michael J Gaunt6,
  7. Michelle Bryson Opfermann7,
  8. Christine Rash Foanio8,
  9. Suzanne Falck9,
  10. Nicole Mirea10
  1. 1Communication Studies, Northwestern University, Chicago, Illinois, USA
  2. 2Speech, Language, and Hearing Sciences, Hofstra University, Hempstead, New York, USA
  3. 3Department of Medicine, University of Illinois, Chicago, Illinois, USA
  4. 4Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
  5. 5Harvard Medical School, Boston, Massachusetts, USA
  6. 6Institute for Safe Medication Practices, Plymouth Meeting, Pennsylvania, USA
  7. 7Takeda Pharmaceuticals America Inc, Lexington, Massachusetts, USA
  8. 8Regulatory Affairs, Novo Nordisk Inc, Princeton, New Jersey, USA
  9. 9Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
  10. 10Plinth Analytics, Los Angeles, California, USA
  1. Correspondence to Professor Bruce L Lambert; bruce.lambert@northwestern.edu

Abstract

Background Wrong-drug medication errors are common. Regulators screen drug names for confusability, but screening methods lack empirical validation. Previous work showed that psycholinguistic tests on pairs of drug names are associated with real-world error rates in chain pharmacies. However, regulators evaluate individual names not pairs, and individual names can be confused with multiple drugs (eg, hydroxyzine with hydralazine but also hydrocet, thorazine, hydrochlorothiazide). This study examines whether an individual drug name’s performance on psycholinguistic tests correlates with that name’s sum total error rate in the real world.

Methods Nineteen pharmacists and 18 pharmacy technicians completed memory and perception tests assessing confusability of 77 drug names. Tests involved presenting a drug name to participants in conditions that hindered their ability to see, hear or remember the name. Participants typed the name they perceived and selected that name from a menu of alternatives. Error rates on the tests were assessed in relation to real-world rates, as reported by the patient safety organisation associated with a national pharmacy chain in the USA.

Results Mean error rate on the psycholinguistic tests was positively correlated with the log-adjusted real-world error rate (r=0.50, p<0.0001). Linear and mixed effects logistic regression analyses indicated that the lab-measured error rates significantly predicted the real-world error rates and vice versa.

Conclusions Lab-based psycholinguistic tests are associated with real-world drug name confusion error rates. Previous work showed that such tests were associated with error rates of specific look-alike sound-alike pairs, and the current work showed that lab-based error rates are also associated with an individual drug’s overall error rate. Taken together, these studies validate the use of psycholinguistic tests in assessing the confusability of proposed drug names.

  • Patient Safety
  • Human error
  • Medical error, measurement/epidemiology
  • Medication safety
  • Pharmacists

Data availability statement

Data are available upon reasonable request. Not applicable.

https://doi.org/10.1136/bmjqs-2024-017688

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Data availability statement

Data are available upon reasonable request. Not applicable.

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Footnotes

  • X @bruce_lambert

  • Contributors BLL is the guarantor of the project. He oversaw every aspect of the project, obtained the funding and the data, drafted and submitted the manuscript. SRS contributed to every phase of the project and was primarily responsible for collecting the data. WG contributed to the design and analysis of the project and led the team that selected the study names. GS, AJV, MJG, MBO, CRF and SF contributed to the design of the experiments and the selection and preparation of the study names. NM contributed to the analysis of the data. All listed authors contributed to the drafting and revision of the manuscript, gave approval of the final published version and will take public accountability for the project’s results.

  • Funding This study was funded by Agency for Healthcare Research and Quality (U19HS021093).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer-reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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