Tall man lettering (tall-man lettering or tallman lettering) is the practice of writing part of a

drug A drug is any chemical substance that causes a change in an organism's physiology or psychology when consumed. Drugs are typically distinguished from food and substances that provide nutritional support. Consumption of drugs can be via insuffla ...

's name in

upper case Letter case is the distinction between the letters that are in larger uppercase or capitals (or more formally ''majuscule'') and smaller lowercase (or more formally ''minuscule'') in the written representation of certain languages. The writing ...

letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors. For example, in tall man lettering, "

prednisone Prednisone is a glucocorticoid medication mostly used to immunosuppressive drug, suppress the immune system and decrease inflammation in conditions such as asthma, COPD, and rheumatologic diseases. It is also used to treat high blood calcium ...

" and "

prednisolone Prednisolone is a steroid medication used to treat certain types of allergies, inflammatory conditions, autoimmune disorders, and cancers. Some of these conditions include adrenocortical insufficiency, high blood calcium, rheumatoid arthrit ...

" should be written "predniSONE" and "predniSOLONE", respectively. The Office of Generic Drugs of the US

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...

(FDA) encourages

manufacturers Manufacturing is the creation or production of goods with the help of equipment, labor, machines, tools, and chemical or biological processing or formulation. It is the essence of secondary sector of the economy. The term may refer to a range ...

to use tall man lettering labels to visually differentiate their drugs' names, and a number of hospitals, clinics, and health care systems use tall man lettering in their computerized order entry, automated dispensing machines, medication admission records, prescription labels, and drug product labels.

Effectiveness

Wrong-drug errors have been found to occur at a rate of about one per thousand orders filled or dispensed. Evidence regarding the effect of Tall Man lettering on error rates is mixed. A 2004

eye-tracking Eye tracking is the process of measuring either the point of gaze (physiology), gaze (where one is looking) or the motion of an eye relative to the head. An eye tracker is a device for measuring eye positions and Eye movement (sensory), eye mo ...

study found that Tall Man lettering resulted in fewer errors when selecting a target drug from an array of choices. Other laboratory-based studies of Tall Man lettering show a mixture of positive and

null result In science, a null result is a result without the expected content: that is, the proposed result is absent. It is an experimental outcome which does not show an otherwise expected effect. This does not imply a result of zero or nothing, simply a res ...

s, which may be further complicated due to

demand characteristics In social research, particularly in psychology, the term demand characteristic refers to an experimental artifact where participants form an interpretation of the experiment's purpose and subconsciously change their behavior to fit that interpretat ...

of some of the studies. A 2016

time-series analysis In mathematics, a time series is a series of data points indexed (or listed or graphed) in time order. Most commonly, a time series is a sequence taken at successive equally spaced points in time. Thus it is a sequence of discrete-time data. Exa ...

of data from 42 children's hospitals over a 9-year period found no significant difference before and after a 2007 recommendation for hospitals to adopt Tall Man lettering. However, this study has been criticized due to methodological limitations, such as not recording when and how Tall Man lettering was adopted, if at all, at each of the hospitals studied.

Examples

The FDA published a listPDF attachment (registration needed, 2011 version)
/ref> of recommended Tall-Man Letters for look-alike drugs which includes, but is not limited to: *

acetaZOLAMIDE Acetazolamide, sold under the trade name Diamox among others, is a medication used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension (raised brain pressure of unclear cause), urine alkalin ...

vs.

acetoHEXAMIDE Acetohexamide (trade name Dymelor) is a first-generation sulfonylurea medication used to treat diabetes mellitus type 2, particularly in people whose diabetes cannot be controlled by diet alone. Mechanism of action Acetohexamide bind to an AT ...

buPROPion Bupropion, sold under the brand names Wellbutrin and Zyban among others, is an atypical antidepressant primarily used to treat major depressive disorder and to support smoking cessation. It is also popular as an add-on medication in the case ...

vs.

busPIRone Buspirone, sold under the brand name Buspar, among others, is a medication primarily used to treat anxiety disorders, particularly generalized anxiety disorder. Benefits support its short-term use. It is taken by mouth, and it may take up to fo ...

chlorproMAZINE Chlorpromazine (CPZ), marketed under the brand names Thorazine and Largactil among others, is an antipsychotic medication. It is primarily used to treat psychotic disorders such as schizophrenia. Other uses include the treatment of bipolar dis ...

vs.

chlorproPAMIDE Chlorpropamide is a drug in the sulfonylurea class used to treat diabetes mellitus type 2. It is a long-acting first-generation sulfonylurea. Mechanism of action Like other sulfonylureas, chlorpropamide acts to increase the secretion of insulin, ...

clomiPHENE Clomifene, also known as clomiphene, is a medication used to treat infertility in women who do not ovulate, including those with polycystic ovary syndrome. Use results in a greater chance of twins. It is taken by mouth once a day, with a course ...

vs.

clomiPRAMINE Clomipramine, sold under the brand name Anafranil among others, is a tricyclic antidepressant (TCA). It is used for the treatment of obsessive–compulsive disorder, panic disorder, major depressive disorder, and chronic pain. It may increase th ...

cycloSERINE Cycloserine, sold under the brand name Seromycin, is a GABA transaminase inhibitor and an antibiotic, used to treat tuberculosis. Specifically it is used, along with other antituberculosis medications, for active drug resistant tuberculosis. It ...

vs.

cycloSPORINE Ciclosporin, also spelled cyclosporine and cyclosporin, is a calcineurin inhibitor, used as an immunosuppressant medication. It is a natural product. It is taken orally or intravenously for rheumatoid arthritis, psoriasis, Crohn's disease ...

DAUNOrubicin Daunorubicin, also known as daunomycin, is a chemotherapy medication used to treat cancer. Specifically it is used for acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), chronic myelogenous leukemia (CML), and Kaposi's sarcoma. It ...

vs.

DOXOrubicin Doxorubicin, sold under the brand name Adriamycin among others, is a chemotherapy medication used to treat cancer. This includes breast cancer, bladder cancer, Kaposi's sarcoma, lymphoma, and acute lymphocytic leukemia. It is often used togeth ...

DOBUTamine Dobutamine is a medication used in the treatment of cardiogenic shock (as a result of inadequate tissue perfusion) and severe heart failure. It may also be used in certain types of cardiac stress tests. It is given by IV only, as an injection ...

vs.

DOPamine Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic compound, organic chemical of the catecholamine and phenethylamine families. Dopamine const ...

hydrALAzine Hydralazine, sold under the brand name Apresoline among others, is a medication used to treat high blood pressure and heart failure. This includes high blood pressure in pregnancy and very high blood pressure resulting in symptoms. It has bee ...

vs.

hydrOXYzine Hydroxyzine, sold under the brand names Atarax, Vistaril and others, is an antihistamine medication. It is used in the treatment of itchiness, insomnia, anxiety, and nausea, including that due to motion sickness. It is used either by mouth or in ...

TOLAZamide Tolazamide is an Wiktionary:oral, oral blood glucose lowering medication, drug used for people with Type 2 diabetes. It is part of the sulfonylurea (medicine), sulfonylurea family (ATC A10BB). Synthesis para-toluenesulfonamide, ''para''-Toluene ...

vs.

TOLBUTamide Tolbutamide is a first-generation potassium channel blocker, sulfonylurea oral hypoglycemic medication. This drug may be used in the management of type 2 diabetes if diet alone is not effective. Tolbutamide stimulates the secretion of insulin by ...

vinBLAStine Vinblastine (VBL), sold under the brand name Velban among others, is a chemotherapy medication, typically used with other medications, to treat a number of types of cancer. This includes Hodgkin's lymphoma, non-small cell lung cancer, bladder ca ...

vs.

vinCRIStine Vincristine, also known as leurocristine and marketed under the brand name Oncovin among others, is a chemotherapy medication used to treat a number of types of cancer. This includes acute lymphocytic leukemia, acute myeloid leukemia, Hodgkin's ...

The

Institute for Safe Medication Practices The Institute for Safe Medication Practices (ISMP) is an American 501(c)(3) organization focusing on the prevention of medication errors and promoting safe medication practices. It is affiliated with the ECRI Institute ECRI (originally founded ...

(ISMP) has a supplemental list covering pairs not recommended by the FDA, but considered necessary by the ISMP. ISMP Canada also offers additional recommendations.

References

External links

ISMP updates its list of drug name pairs with TALL man letters
November 18, 2010 * {{cite web , title=Drug Labelling and the Application of TALLman Lettering Project Report , url=https://www.ismp-canada.org/download/TALLman/TALLmanLettering-ProjectReport.pdf , website=Institute for Safe Medication Practices Canada , date=March 2016 – for an overview, and for a list of TALLman respelling systems Health informatics Pharmacy Capitalization

Effectiveness

Examples

See also

References

External links