Effects of Tall Man Lettering and Position in Discriminating Confusable Drug Names

Medical errors are now estimated to be the third leading cause of death in the United States (Makary & Daniel, 2016). Look-alike, sound- alike prescription drug mix-ups contribute to this figure. The US Food and Drug Administration (FDA) and Institute for Safe Medication Practices (ISMP) have recommended the use of Tall Man lettering since 2008, in which dissimilar portions of confusable drug names pairs are capitalized in order to make them more distinguishable. Research on the efficacy of Tall Man lettering in differentiating confusable drug name pairs has been inconclusive and it is imperative to investigate potential efficacy further considering the clinical implications (Lambert, Schroeder & Galanter, 2015). The present study aimed to add to the body of research on Tall Man lettering while also investigating another possibility for the mechanism behind Tall Man’s efficacy, if it in fact exists. Studies indicate that the first letter in a word offers an advantage over other positions, resulting in more accurate and faster recognition (Adelman, Marquis & Sabatos-DeVito, 2010; Scaltritti & Balota, 2013). The present study used a 2x3 repeated measures design to analyze the effect of position on Tall Man lettering efficacy. Participants were shown a prime drug, followed by a brief mask, and then either the same drug name or its confusable pair and asked to identify whether they were the same or different. All participants completed both lowercase and Tall Man conditions. Overall performance measured by accuracy and reaction time revealed lowercase to be more effective than Tall Man. With regard to the position of Tall Man letters, a first position advantage was seen both in accuracy and reaction time. A first position advantage was seen in the lowercase condition as well, suggesting the location of the differing portion of the word matters more than the format used. These findings add to the body of inconclusive research on the efficacy of Tall Man lettering in drug name confusion. Considering its impact on patient safety, more research should be conducted to definitively answer the question as to whether or not Tall Man should be used in practice.