Measuring the Efficacy of Tall Man Lettering

Currently, medical errors are one of the most common causes of death in the United
States (Makary & Daniel, 2016), which includes errors related to look-alike, sound-alike prescription drug name confusion. The use of Tall Man lettering, a text enhancement style that capitalizes the dissimilar portions of words, has been recommended by the US Food and Drug Administration (FDA) as well as the Institute for Safe Medication Practices (ISMP) since 2008 in order to make it easier for healthcare professionals to distinguish and identify two otherwise easily confusable drug names. Research performed on the efficacy of Tall Man lettering and similar text enhancements in successfully differentiating look-alike, sound-alike drug names has thus far been either null or inconclusive. Therefore, it is crucial that further research be conducted in order to provide a path to alleviation by increasing the understanding of the problem, and providing evidence to a clearer solution (Lambert, Schroeder & Galanter, 2015). The objective of the current study was to measure the efficacy of Tall Man Lettering and additional text enhancement strategies through an experiment that replicates some of the previously used methods of research. The current study utilized a repeated measures design. Participants were shown a prime drug name, followed by a brief mask, and then either the same drug name or its confusable drug name pair. They were then asked to identify whether the two drug names presented were identical or different. All of the participants completed a total of four trials representing each condition (regular, Tall Man, Tall Man Bold, highlight) and a practice trial. Overall performance was measured through accuracy and reaction time, which revealed that regular, lowercase text was more effective than any of the other text enhancements, including Tall Man lettering, in quickly and accurately identifying differences in drug names. These results seem to add to the body of inconclusive research on the efficacy of Tall Man lettering and similar text enhancement strategies for reducing drug name confusion. Given the significant impact that drug name confusion errors can have on patient safety, it is imperative that further research be conducted in order to give a more definitive answer of whether text enhancement strategies like Tall Man lettering are helpful in practice.