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Patient Safety in Medication Nomenclature: Orthographic and Semantic Properties
of International Nonproprietary Names
#MMPMID26701761
Bryan R
; Aronson JK
; ten Hacken P
; Williams A
; Jordan S
PLoS One
2015[]; 10
(12
): e0145431
PMID26701761
show ga
BACKGROUND: Confusion between look-alike and sound-alike (LASA) medication names
(such as mercaptamine and mercaptopurine) accounts for up to one in four
medication errors, threatening patient safety. Error reduction strategies include
computerized physician order entry interventions, and 'Tall Man' lettering. The
purpose of this study is to explore the medication name designation process, to
elucidate properties that may prime the risk of confusion. METHODS AND FINDINGS:
We analysed the formal and semantic properties of 7,987 International
Non-proprietary Names (INNs), in relation to naming guidelines of the World
Health Organization (WHO) INN programme, and have identified potential for
errors. We explored: their linguistic properties, the underlying taxonomy of
stems to indicate pharmacological interrelationships, and similarities between
INNs. We used Microsoft Excel for analysis, including calculation of Levenshtein
edit distance (LED). Compliance with WHO naming guidelines was inconsistent.
Since the 1970s there has been a trend towards compliance in formal properties,
such as word length, but longer names published in the 1950s and 1960s are still
in use. The stems used to show pharmacological interrelationships are not spelled
consistently and the guidelines do not impose an unequivocal order on them,
making the meanings of INNs difficult to understand. Pairs of INNs sharing a stem
(appropriately or not) often have high levels of similarity (<5 LED), and thus
have greater potential for confusion. CONCLUSIONS: We have revealed a tension
between WHO guidelines stipulating use of stems to denote meaning, and the aim of
reducing similarities in nomenclature. To mitigate this tension and reduce the
risk of confusion, the stem system should be made clear and well ordered, so as
to avoid compounding the risk of confusion at the clinical level. The interplay
between the different WHO INN naming principles should be further examined, to
better understand their implications for the problem of LASA errors.
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