Effects of task- and environment-related interventions on the performance in differentiation and visual search of look-alike drug names using simulation and eye-tracking techniques

Abstract

Background: Confusing look-alike drug names can harm patients’ safety and health. Ergonomic designs by emphasizing the differences of look-alike drug names (i.e., typographical method) have shown potential to improve name discrimination and perception. However, existing literature releases sparse and mixed evidence on the efficacy of typographical method. In addition, most studies were computer-based designs, which may block the generalization of findings from such designs to real-world settings. Moreover, few studies evaluated the interaction between typographical method and environmental interventions in reducing confusion errors. The dissertation was designed to fill these research gaps. Objectives: To examine the effects of typographical method, orthographic similarity, and pharmacy background on the differentiations of look-alike drug names; and to evaluate the influences of typographical method, format consistency, attention grabber, and time pressure on the visual searching of drugs that have look-alike names. Methodology: The dissertation was comprised of three experiments. A computer-based same/different judgement task was performed by 40 student pharmacists and 40 non-pharmacy students to examine the effects of typographical method, orthographic similarity, and pharmacy background on name differentiations (Experiment 1). For visual searching of look-alike drug names, two other experiments were conducted to assess the effects of typographical method, format consistency, attention grabber, and time pressure. Forty healthcare professionals in nursing were tested by performing a visual searching task in a high fidelity simulated pharmacy environment (Experiment 2) and another forty were tested with their eyes tracked in a computer-based design (Experiment 3). Results: In Experiment 1, all textual enhancement methods enabled participants to differentiate names more accurately and more easily than lowercase. A high degree of orthographic similarity yielded increased error rate and longer response time. Relative to non-pharmacy students, student pharmacists distinguished names more accurately and more easily. In Experiment 2, no textual enhancement method outperformed lowercase in the visual searching task. Response time was shortened if name formats on prescriptions and packages were identical. Turning on attention grabbers produced shorter response time, fewer mental efforts, and lower error likelihood. Participants perceived more mental efforts when co-workers or customers urged them in drug searching. In Experiment 3, highlighting the differences of look-alike drug names did not facilitate visual searching. Response time, fixation count, and fixation duration were lower when using identical formats on prescriptions and packages. Using attention grabbers improved accuracy, shortened response time, and reduced fixation count and duration. Conclusions: Highlighting the primary different portions of look-alike drug names (e.g., in boldface plus Tall Man lettering) could make names more distinctive, but it should not be the primary strategy to reduce confusion errors based on its non-significant influences on visual searching. More efforts should be paid on environmental interventions. Some recommendations are proposed: name formats on prescriptions and drug packages should be consistent; indicator lights to hint healthcare providers about locations of target drugs should be equipped on pharmacy shelves; co-workers and customers should not urge healthcare providers who are selecting drugs.