Effects of Text Enhancement, Identical Prescription-Package Names, Visual Cues, and Verbal Provocation on Visual Searches of Look-Alike Drug Names: A Simulation and Eye-Tracking Study.

Abstract

Simulation and eye tracking were used to examine the effects of text enhancement, identical prescription-package names, visual cues, and verbal provocation on visual searches of look-alike drug names. Look-alike drug names can cause confusion and medication errors, which jeopardize patient safety. The effectiveness of many strategies that may prevent these problems requires evaluation. We conducted two experiments that were based on a four-way, repeated-measures design. The within-subject factors were text enhancement, identical prescription-package names, visual cues, and verbal provocation. In Experiment 1, 40 nurses searched for and selected a target drug from an array of drug packages on a pharmacy shelf mock-up. In Experiment 2, the eye movements of another 40 nurses were tracked while they performed a computer-based drug search task. Text enhancement had no significant effect on the drug search. Nurses selected the target drugs more quickly and easily when the prescriptions and drug packages shared identical drug name formats. The use of a visual cue to direct nurses' attention facilitated their visual searches and improved their eye gaze behaviors. The nurses reported greater mental effort if they were provoked verbally during the drug search. Efficient and practical strategies should be adopted for designs that facilitate accurate drug search. Among these strategies are using identical name appearances on drug prescriptions and packages, using a visual cue to direct nurses' attention, and avoiding rushing nurses while they are concentrating. The findings aim to inspire recommendations for work system designs that will improve the visual search of look-alike drug names.