Medication Line

Prepared for NHS Connecting for Health Version 2.0.0.0 Baseline Prepared by Clinical Applications and Patient Safety Project NHS CUI Programme Team Cuistakeholder.mailbox@hscic.gov.uk

PREFACE

PREFACE
1 INTRODUCTION
2 GUIDANCE OVERVIEW
- 2.1 Summary of Guidance
3 GUIDANCE DETAILS
4 DOCUMENT INFORMATION
APPENDIX A REFERENCE SUMMARY OF GUIDANCE
REVISION AND SIGNOFF SHEET

Source PDF: medline.pdf

Documents replaced by this document Medications Management – Medication Line – User Interface Design Guidance 1.0.0.0 Documents to be read in conjunction with this document Design Guide Entry – Medications Management – Medications Views 2.0.0.0 Design Guide Entry – Medications Management – Drug Administration 3.0.0.0 Design Guide Entry – Patient Banner 3.0.0.0 Patient Safety Process The development cycle for this design guide is compliant with the Clinical Safety Management System (CSMS) – the patient safety risk assessment and management process defined by NHS Connecting for Health (NHS CFH) in conjunction with the National Patient Safety Agency (NPSA). The design guide developers reviewed patient safety incidents arising from both current practice and existing systems for medications management. The resulting guidance points support mitigation of these known patient safety risks. In addition, the developers identified any potential new risks by applying a patient-safety risk-assessment process. The developers are assessing and managing all risks to support a Clinical Safety Case for this design guide. The Hazard Log records all hazards and risks raised to date and includes mitigation actions that, in some cases, will be applicable to you if you are an implementer or other user of this design guide. The Hazard Log is a live document and updates regularly whilst this design guide continues its development. Until this design guide has received full Clinical Authority to Release (CATR) from the NHS CFH Clinical Safety Group (CSG) – based on an approved Clinical Safety Case – there may be outstanding patient safety risks yet to be identified and mitigated. Therefore, it is essential that you review the relevant Hazard Log in conjunction with this design guide. Refer to nww.cui.nhs.uk (N3 connection required) for all current patient safety documentation, including Hazard Logs and the current patient safety process status for this and other design guides. This document was prepared for NHS Connecting for Health which ceased to exist on 31 March 2013. It may contain references to organisations, projects and other initiatives which also no longer exist. If you have any questions relating to any such references, or to any other aspect of the content, please contact cuistakeholder.mailbox@hscic.gov.uk

1 INTRODUCTION

This document provides guidance for the representation of a medication in a user interface (UI). It describes the area of focus, lists mandatory and recommended guidance points with usage examples and explains the rationale behind the guidance.

This document replaces the previously published guidance Medications Management – Medication Line {R1} . It has been extended to provide formatting and layout rules that add structure and consistency to the way that medications are displayed in a user interface.

Table 1 describes the changes made since the previous version of this document:

1.0.0.0 28-Mar-2008 The following table summarises updates that have been made to this document:

Deleted :

 MEDi-006 deleted to remove constraint to UK or NHS standards

Modified :

 MEDi-002 includes additional information that cites exceptions in which capital letters can be

used in a generic drug name

 MEDi-004 has been split into MEDi-023 and MEDi-026. These two guidance points are listed in

separate sections to provide more detailed guidance for truncation and abbreviation respectively

 MEDi-005 has been split into MEDi-018 and MEDi-027. These two guidance points are listed in

separate sections to provide more detailed guidance for separators and symbols respectively

 MEDi-007 has been updated to mandate the use of the word ‘DOSE’ in a text label for a dose

value

 MEDI-010, MEDi-011 and MEDi-012 have been reworded to clarify the guidance

Added :

 A further 42 guidance points, MEDi-013 to MEDi-054, have been added. Refer to section 2.1 for

more details

Table 1: Changes Since the Last Baseline Version

Note

In this document, the words ‘generic’ and ‘brand’, when associated with drug names, are used with very specific meanings that may differ from their accepted meanings in other contexts. Refer to section 4.2 for definitions of the specific terminology used in this document.

1.1 Customer Need

An electronic – system for managing a patient’s medications must be able to support the complex needs of a wide range of health care professions and health care settings. A successful display solution must therefore balance those complex information needs with safety concerns, and ensure consistency across views and between systems.

Medications Incidents - The National Patient Safety Agency (NPSA) reports that the majority of medication incidents reported between January 2005 and June 2006 related to the administration of medicines (59.3 percent), followed by incidents related to the preparation and dispensing of medications (17.8 percent) and the prescribing of medications (15.7 percent). Their findings, documented in Safety in doses: medication safety incidents in the NHS [1], also state that the most

1 NPSA – Safety in doses: medication safety incidents in the NHS {R2} : http://www.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=5535

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common types of medication incidents reported to the NSPA included incorrect dose, incorrect strength or frequency, omitted medicine and wrong medicine.

Existing Systems - In-patient hospital care settings currently use multiple kinds of medications documents, both paper-based and electronic. As care professionals move between hospitals and are faced with new information groupings while working in stressful environments, the differences in the designs of the documents they use may well already impact patient safety. Differences in display formats for medicines impact both the review and management of those medications and will become a safety concern as electronic systems become more widely available in the next few years. The challenge for designers developing electronic systems in this area is particularly great as there are no universally-accepted paper-based standards to reference.

Research in which extensive studies of medication-related errors were reviewed, suggests that the most powerful means of preventing medication-related errors are computerised order entry and administration management along with standards for processes and for the writing of prescriptions (see Medication Errors {R3}, To Err Is Human {R4} and Understanding Patient Safety {R5} ).

Anecdotal references to medication errors most frequently describe problems with legibility of handwritten scripts, the use of abbreviations, translation errors in verbal communications and mistakes exacerbated by similar looking bottles or product labels and similar looking or similar sounding drug names. These well-documented errors focus on specific elements of a medication order, as do the means by which we mitigate them. In addition to these specific errors, there is a need to ensure that medications orders are more thorough in terms of the information they contain, and that they are created, structured, displayed and communicated in a consistent way. Mitigations of this kind may also address the specific errors described above, by providing additional information in a medication order in a way that leaves less room for misinterpretation.

1.2 Scope

This guidance has been designed for the display of medications for a single patient in a hospital ward environment. The guidance applies to the display of the details of a medication including drug name, strength, form, dose, route and frequency. The additional information about medication required for safe medication management, review and modification is out of scope.

1.2.1 In Scope

The guidance in this document covers the following features:

Line item display rules:

 Generic rules for the display of medication including wrapping, truncation, abbreviation, spacing, fonts formatting and labelling

The following users are covered in this guidance:

Doctors and other independent prescribers
Nurses with responsibility for medicines administration
Pharmacists

The following care settings are covered in this guidance:

Inpatient

The following medications are covered in this guidance:

Oral solids and liquids
Inhalers and sprays
Eye, ear and nose drops

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Topical liquids
Creams, ointments and gels
Enemas and rectal solutions
Granules and powders
Suppositories and pessaries
Topical patches
Nebuliser solutions
Simple infusions (by example only)
Injections (insulin example only)
Unlicensed medications

1.2.2 Out of Scope

Although there may be specific risks associated with the out of scope areas that are not addressed in this guidance, it is likely that the principles in this guidance will extend to the display of medication information in many of the areas listed below.

The following features are not covered in this guidance:

The display of all information about a single medication:

 Guidance for the layout and structure for the presentation of ‘all’ information for one medication from the selection of a medication anywhere in a clinical application

Identity of a medication:

 Definition of which attributes can be changed without the need for a new medication line to be created (in the UI)

The following users are not covered in this guidance:

Other health care professionals
Senior nurse (for ward management and multi-patient tasks)
Non-clinical staff
Patient

Note

The patient is out of scope because the guidance is designed to support user interfaces used by clinicians. As such, it will therefore present information in formats that are designed to support health care professionals. The display of medication information in views that are designed for patients is not addressed in this guidance.

The following care settings are not covered in this guidance:

Outpatients
Clinics
Pharmacies
Emergency services and departments

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Intensive Care, High Dependency Unit (HDU)
Primary care, including General Practice
Community and home visits

The following types of medications are not covered in this guidance:

Enteral feeds
Dressings and devices
Implants and sticks
Intrauterine devices (IUDs)
Cements
Homeopathic products (including complementary and alternative therapies)
Dialysis solutions
Injections (except by specific example)
Insulin (except by specific example)
Infusions and fluids (except by specific examples)
Combination infusions
Total Parental Nutrition (TPN)
Gases
Blood and platelet products
Radio-pharmacy
Variable dose medications (by example only)
Foams
Radioactive agents
Regimens and order sets
Advisory Committee on Borderline Substances (ACBS) products
Over the counter (OTC) medications
Recreational drugs
Medications with titrating doses
Discharge medications – to take out (TTO)
Patient’s own drugs (PODs)
Epidurals and analgesia (and similar patient controlled medications)
Extemporaneous prescriptions
Medication prescribed by Patient Group Direction (PGD)
Medication prescribed by supplementary prescribers

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The following are also not covered in this guidance:

Sealed envelopes
Decision support
Knowledge support
Alerts and warnings
When a patient is ‘Nil by Mouth’
Allergies
Patient preference (for example, for a particular drug form)

1.3 Dependencies

D1 This guidance is informed by ongoing and unpublished work by the NHS National Programme for IT (NPfIT) that is referred to in this document as NHS Connecting for Health (NHS CFH) Medication Types Rules. The NHS CFH Medication Types Rules is still evolving and is based on extensive research and consultation. Changes to this work will trigger changes to this guidance.

D2 The guidance points in section 3.3.1 are particularly dependent on research into the application of Tallman lettering, as documented by the Institute for Safe Medication Practices (ISMP) in How should Tallman lettering be applied to look- alike/sound-alike drug name pairs? [2]. In summary, Tallman lettering is a proposed solution for mitigating the risks of ‘lookalike, sound-alike’ drug names. Tallman lettering is mandated in the US and recommended by the World Health Organization (WHO) in Look-Alike Sound-Alike Medication Names [3]. The uptake of Tallman lettering in electronic prescribing in the UK would require a review of the use of capital letters for differentiating brand names, and is currently the subject of an ongoing NHS CFH research project.

D3 This guidance is informed by the NHS CFH ePrescribing Functional Specification [4].

D4 This guidance uses the concepts ‘generic drug’ and ‘brand name’ and depends on access to, or creation of, a database or dictionary, that can support these concepts, such as the Dictionary of Medicines and Devices (known as ‘dm+d’) [5].

Table 2: Dependencies

2 The Institute for Safe Medication Practices – Frequently Asked Questions (FAQ) – How should Tallman lettering be applied to look-alike/sound-alike drug name pairs? {R6} : http://www.ismp.org/faq.asp#Question_5

3 World Health Organization – WHO Collaborating Centre for Patient Safety Releases – Patient Safety Solutions – Volume 1, Solution 1 – Look-Alike, Sound-Alike Medication Names {R7} : http://www.ccforpatientsafety.org/fpdf/Presskit/PS-Solution1.pdf

4 NHS CFH – ePrescribing Functional Specification {R8} : http://www.connectingforhealth.nhs.uk/newsroom/news-stories/eprescfunctspec

5 Dictionary of Medicines and Devices {R9} : http://www.dmd.nhs.uk/

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2 GUIDANCE OVERVIEW

When a medication is prescribed, a series of choices are made about the type of medication and the way in which it is to be administered. Assuming that the prescribing and administration of a medication is recorded electronically, those choices are then represented in various degrees of detail and in different areas of a user interface. For example, a summary of the prescription might be displayed in a patient summary, a more detailed set of information might be displayed in a list of that patient’s current medications and a different set of detailed information might be displayed in an electronic drug administration schedule.

The details that are displayed on the screen, as well as the formatting and layout applied to them, will vary depending on the purpose of the part of the clinical application in which they are being displayed. Some views will show medications information in text while others will show some of that information encoded visually. A text description of a medication in any of these views is referred to in guidance as a ‘medication line’.

Guidance for two medication views, Medications Management – Medication View {R10} and Medications Management – Drug Administration {R11}, define specific layout and details for the display of medication information in those views. The guidance in this document includes layout and formatting details that apply to all views that are designed to support medications management for a single patient in a hospital ward.

It is likely that many of the principles in this guidance will extend to the display of medication information in all areas of a clinical application.

Figure 1 illustrates how the guidance can be applied to four different styles of medication line in four notional views:

diltiazem - CALCICARD CR – modified-release tablet – DOSE 120 mg - oral – three times a day

diltiazem - CALCICARD CR – modified-release tablet DOSE 120 mg ROUTE oral – three times a day

diltiazem - CALCICARD CR – modified-release tablet DOSE 120 mg - oral – three times a day

diltiazem - CALCICARD CR FORM modified-release tablet DOSE 120 mg ROUTE oral FREQUENCY three times a day

Figure 1: Examples of Medication Line Guidance Applied to a Medication Line in Four Notional Views

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2.1 Summary of Guidance

Detailed guidance and rationale for all guidance points is in sections 3.3.1 to 3.3.13. Refer to APPENDIX A for a reference list of all the guidance descriptions. Table 3 provides a summary of the guidance.

Note

In the Visual Summary column, items highlighted in blue indicate correct usage and those in red indicate incorrect usage.

MEDi-001 MEDi-002 MEDi-003 MEDi-013

MEDi-014 to MEDi-017

MEDi-018 to MEDi-020

MEDi-010 MEDi-011 MEDi-021 MEDi-008

MEDi-022 to MEDi-024

MEDi-025 MEDi-012 MEDi-054

MEDi-026 to MEDi-028

3.3.1 Formatting Drug Names

How to use bold, uppercase and lowercase to support recognition of generic versus brand names.

3.3.2 Displaying Numbers

How to display numbers including large numbers with many zeros and numbers that use decimal points.

3.3.3 Separators

How to use separators to support recognition of chunks of information combined into a text string like a sentence.

3.3.4 Wrapping

How to determine where to wrap the text in a medication line when horizontal space is limited.

3.3.5 Abbreviation

How to handle specific examples of abbreviation and abbreviations that should be avoided.

3.3.6 Truncation

Specific examples of when it is important to avoid truncation.

3.3.7 Symbols

When to use specific symbols and symbols that should be avoided.

Col1	generic	brand

diltiazem– CALCICARD CR – modified-release tablet – `DOSE` 120 mg – oral – twice a day	diltiazem– CALCICARD CR – modified-release tablet – `DOSE` 120 mg – oral – twice a day	diltiazem– CALCICARD CR – modified-release tablet – `DOSE` 120 mg – oral – twice a day

Col1	paracetamol

para – tablet –`DOSE` 500 mg – oral – every 6 hours	para – tablet –`DOSE` 500 mg – oral – every 6 hours

Col1	i

heparin– 5,000 units per mL – solution for in	heparin– 5,000 units per mL – solution for in

Do not truncate or omit information from a medication line

@ & | / \ < > ( ) [ ] { }

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MEDi-009 MEDi-029 to MED-034

3.3.8 Text Labels

How and when to use text labels.

MEDi-035 3.3.9 Line Breaks

Where to place separators when hard line breaks are used.

Preserve white space between lines

MEDi-036 MEDi-037

MEDi-007 MEDi-038 to MEDi-044

MEDi-045 to MEDi-050

MEDi-051 to MEDi-053

3.3.10 Line Spacing

How much space to leave between lines of text.

3.3.11 Displaying Dose

How to use labels and text formatting to support recognition of a dose within a medication line. How to display numbers in a dose value.

3.3.12 Displaying Strength

How to use layout and appropriate words to display a strength. How to display numbers in a strength value.

3.3.13 Attribute Order

The order in which to display the chunks of information that make up a medication line.

Col1	label	space

`DOSE` 500 mg	`DOSE` 500 mg	`DOSE` 500 mg

generic - BRAND – strength – form – DOSE dose - route – frequency

Table 3: Summary of Guidance

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3 GUIDANCE DETAILS

3.1 Introduction

This section contains detailed guidance for the display of a medication that has been prescribed for a single patient.

3.2 Principles

The following key principles inform the guidance in this section:

Minimise visual clutter so that formatting and icons are effective for providing emphasis and

implying priorities: draw attention to important information without introducing too much distraction

Support legibility through the use of font, line spacing, and letter spacing and other proven

mechanisms

Define rules to support standard display of medications information wherever possible

whilst allowing flexibility for information to be displayed appropriately for different tasks

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3.3 Guidelines

3.3.1 Formatting Drug Names

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6 Lothian Joint Formulary {R12} Lothian Joint Formulary

7 Northumberland and North Tyneside Drugs and Therapeutics Committee Formulary – Version 1.1 September 2004 {R13} : http://www.gp-training.net/protocol/therapeutics/formulary_northumberland.pdf

8 British National Formulary – BNF No. 56 {R16} : http://bnf.org/bnf/bnf/current/104945.htm

9 British National Formulary – BNF No. 56 – Product Label List {R17} : http://bnf.org/bnf/bnf/current/100159.htm

10 British National Formulary – BNF No. 56 – BNF Extra – Resources – Name changes {R18} : http://bnf.org/bnf/extra/56/450049.htm

11 WHO Drug Information, Vol. 22, No. 1, 2008 – International Nonproprietary Names for Pharmaceutical Substances (INN) {R19} : http://whqlibdoc.who.int/druginfo/INN_2008_list59.pdf

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The ISMP’s Draft Guidelines for Safe Electronic Communication of Medication Orders [15] and NHS CFH’s ePrescribing Functional Specification {R8} and Guidelines for the Design and Presentation of Medication Elements Required in Electronic Prescribing or Medication Ordering Systems {R24}, have recommendations and guidelines that advise the use of lowercase letters for generic names and uppercase letters for brand names.

The WHO’s publication Look-Alike, Sound-Alike Medication Names {R7} provides advice on mitigating the risks of look-alike, soundalike medication names. Their description of the problem and associated issues includes reference to the potential for confusion between generic and brand names. Their related suggested action is to:

“…include both the non-proprietary name and the brand name of the medication on medication orders and labels, with the nonproprietary name in proximity to, and in larger font size than the brand name.”

In this document, generic names are shown in bold lowercase and brand names in title case italics.

Guidance is supported by the prevalence of an emerging convention in which generic drug names are displayed in lowercase. Guidance also follows one of a few commonly used conventions for displaying brand names. It thus aims to introduce consistency and achieve the benefits described above whilst minimising the impact of potential conflict with existing conventions.

12 Medica – Over-the-Counter Drug List {R20} : http://member.medica.com/router/default.pdf?doc=/C15/DrugFormulary/Document%20Library/OTC_Druglist_2007.pdf

13 Vista Healthplans – Formulary Drug List 2006 {R21} : http://www.vistahealthplan.com/Static/shared/PDF/Formulary/vista_member_formulary.pdf

14 BlueCross BlueShield of Illinois – 2008 Blue Cross and Blue Shield of Illinois Drug Formulary {R22} : http://www.bcbsil.com/rx/pdf/2008_prescription_drug_formulary.pdf

15 ISMP – ISMP MedicationSafetyAlert! – It’s Time for Standards to Improve Safety with Electronic Communication of Medication Orders – Draft Guidelines for Safe Electronic Communication of Medication Orders {R23} : http://www.ismp.org/Newsletters/acutecare/articles/20030220.asp

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3.3.2 Displaying Numbers

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3.3.3 Separators

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3.3.4 Wrapping

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3.3.5 Abbreviation

16 ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations – November 2003, Volume 8, Issue 24 {R27} : http://www.usp.org/pdf/EN/patientSafety/ismpAbbreviations.pdf

17 The Joint Commission – National Patient Safety Goals – Goal 2B {R28} : http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/08_npsg_facts.htm

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3.3.6 Truncation

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3.3.7 Symbols

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3.3.8 Text Labels

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3.3.9 Line Breaks

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3.3.10 Line Spacing

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space between the lines to mitigate the risk of mis-associating information in one line with the medication in the lines above or below.

3.3.11 Displaying Dose

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3.3.12 Displaying Strength

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3.3.13 Attribute Order

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3.4 Rationale Summary

This section summarises the principles behind the rationale for all guidance points in this document.

General Principles:

Provide support for legibility
Mitigate risks of incorrect selection and mis-interpretation

Usability Principles:

Minimise the use of embellishments (for example, bold, colour, fonts, font sizes, italics,

separators and symbols)

Minimise instances of each type of embellishment within a reading unit
Consistent use of specific embellishments within and preferably between user-interface

contexts or ‘views’

Use words instead of symbols where it is important for removing ambiguity

Existing Standards:

NHS CFH – ePrescribing Functional Specification {R8}
NHS NPfIT – Guidelines for the Design and Presentation of Medication Elements Required

in Electronic Prescribing or Medication Ordering Systems {R24}

ISMP (US) – Draft Guidelines for Safe Electronic Communication of Medication

Orders {R23}

Evolving Standards:

NHS NPfIT – Types of medication item for display and prescribing within Secondary Care

electronic systems {R32}

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4 DOCUMENT INFORMATION

4.1 Terms and Abbreviations

ACBS Advisory Committee on Borderline Substances

AMP Actual Medicinal Product

BNF British National Formulary

CATR Clinical Authority to Release

CSG Clinical Safety Group

CSMS Clinical Safety Management System

CUI Common User Interface

dm+d Dictionary of Medicines and Devices

HDU High Dependency Unit

ISMP The Institute for Safe Medication Practices

IUD Intrauterine Device

NHS National Health Service

NHS CFH NHS Connecting for Health

NPfIT National Programme for IT

NPSA National Patient Safety Agency

OTC Over the Counter

PGD Patient Group Direction

PODs Patient’s Own Drugs

TFN Trade Family Name

TPN Total Parental Nutrition

TTO To Take Out

UI User Interface

VTM Virtual Therapeutic Moiety

WHO World Health Organization

Table 4: Terms and Abbreviations

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4.2 Definitions

NHS Entity Within this document, defined as a single NHS organisation or group that is operated within a single technical infrastructure environment by a defined group of IT administrators.

The Authority The organisation implementing the NHS National Programme for IT (currently NHS Connecting for Health).

Current best practice Current best practice is used rather than best practice, as over time best practice guidance may change or be revised due to changes to products, changes in technology, or simply the additional field deployment experience that comes over time.

Generic drug name This can be a single drug name that refers to a single active ingredient or it can be multiple active ingredients that are prescribed as one drug. In the structure of the dm+d {R9}, this generally equates to a Virtual Therapeutic Moiety (VTM).

Important Note

This definition is for this document only and may not reflect the definitions that are used in clinical practice or healthcare organisations.

Brand name A brand name for a product containing medication. A brand name may be associated with many products. In some cases, the same brand name may be associated with different generic drugs. Future versions of the dm+d {R9} are expected to include a separate entity for brand name, known as Trade Family Name (TFN). In the meantime, the brand name is part of the Actual Medicinal Product (AMP).

Important Note

This definition is for this document only and may not reflect the definitions that are used in clinical practice or healthcare organisations.

Table 5: Definitions

4.3 Nomenclature

This section shows how to interpret the different styles used in this document to denote various types of information.

4.3.1 Body Text

Code Monospace

Script

Other markup languages

Interface dialog names Bold

Field names

Controls

Folder names Title Case

File names

Table 6: Body Text Styles

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4.3.2 Cross References

Current document – sections Section number only

Current document – figures/tables Caption number only

Other project documents Italics and possibly a footnote

Publicly available documents Italics with a footnote

External Web-based content Italics and a hyperlinked footnote

Table 7: Cross Reference Styles

4.4 References

R1. NHS CUI Programme – Design Guide Entry – Medications Management – Medication Line 1.0.0.0

R2. NPSA – Safety in doses: medication safety incidents in the NHS http://www.npsa.nhs.uk/EasySiteWeb/GatewayLink.aspx?alId=5535

R3. Medication Errors – Causes, Prevention, and Risk Management – Cohen M R (Ed) – Jones and Bartlett Publishers

R4. To Err is Human – Building a Safer Health System – Kohn L, Corrigan J, Donaldson M – Washington, DC: National Academy Press, 2000

2007

2004

2000

R5. Understanding Patient Safety – Wachter R M – The McGraw-Hill Companies, Inc, 2008 2008

R6. ISMP – Frequently Asked Questions (FAQ) – How should Tallman lettering be applied to lookalike/sound-alike drug name pairs? http://www.ismp.org/faq.asp#Question_5

R7. WHO Collaborating Centre for Patient Safety Releases – Patient Safety Solutions – volume 1, solution 1 – Look-Alike, Sound-Alike Medication Names http://www.ccforpatientsafety.org/fpdf/Presskit/PS-Solution1.pdf

R8. NHS CFH – ePrescribing Functional Specification http://www.connectingforhealth.nhs.uk/newsroom/news-stories/eprescfunctspec

R9. NHS – dictionary of medicines + devices Welcome to the dm+d website — The NHS Dictionary of Medicines and Devices

2008

May 2007

1.0

Release 2.3

R10. NHS CUI Programme – Design Guide Entry – Medications Management – Medication Views 2.0.0.0

R11. NHS CUI Programme – Design Guide Entry – Medications Management – Drug Administration 3.0.0.0

R12. Lothian Joint Formulary Lothian Joint Formulary

R13. Northumberland and North Tyneside Drugs and Therapeutics Committee – Formulary – Version 1.1 September 2004 http://www.gp-training.net/protocol/therapeutics/formulary_northumberland.pdf

R14. The AARP Guide to Pills – Essential Information on More than 1,200 Prescription & Nonprescription Medications, Including Generics – AARP, Avord, J, Greider, K

July 2008

September 2004

January 2006

R15. Complete Guide to Prescription and Nonprescription Drugs – Griffith H W, Moore S, Boesen, K August 2007

R16. British National Formulary – BNF No. 56 http://bnf.org/bnf/bnf/current/104945.htm

R17. British National Formulary – BNF No. 56 – Product Label List http://bnf.org/bnf/bnf/current/100159.htm

September 2008

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R18. British National Formulary – BNF No. 56 – BNF Extra – Resources – Name changes http://bnf.org/bnf/extra/56/450049.htm

R19. WHO Drug Information, Vol. 22, No. 1, 2008 – International Nonproprietary Names for Pharmaceutical Substances (INN) http://whqlibdoc.who.int/druginfo/INN_2008_list59.pdf

R20. Medica – Over-the-Counter Drug List http://member.medica.com/router/default.pdf?doc=/C15/DrugFormulary/Document%20Library/OTC_ Druglist_2007.pdf

R21. Vista Healthplans – Formulary Drug List 2006 http://www.vistahealthplan.com/Static/shared/PDF/Formulary/vista_member_formulary.pdf

R22. BlueCross BlueShield of Illinois – 2008 Blue Cross and Blue Shield of Illinois Drug Formulary http://www.bcbsil.com/rx/pdf/2008_prescription_drug_formulary.pdf

R23. ISMP – ISMP MedicationSafetyAlert! – It’s Time for Standards to Improve Safety with Electronic Communication of Medication Orders – Draft Guidelines for Safe Electronic Communication of Medication Orders http://www.ismp.org/Newsletters/acutecare/articles/20030220.asp

R24. NHS NPfIT – Guidelines for the Design and Presentation of Medication Elements Required in Electronic Prescribing or Medication Ordering Systems – NPfIT-EP-DB-0003.01

R25. How to limit clinical errors in interpretation of data – Wright P, Jansen C, Wyatt J – Lancet 1998; 352: 1539-43

R26. Helping Clinicians to find data and avoid delays – Nygren E, Wyatt J C, Wright, P – Lancet 1998; 352: 1462-66

R27. ISMP List of Error-Prone Abbreviations, Symbols, and Dose Designations – November 2003, Volume 8, Issue 24 http://www.usp.org/pdf/EN/patientSafety/ismpAbbreviations.pdf

R28. The Joint Commission – National Patient Safety Goals – Goal 2B http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/08_npsg_facts.htm

R29. Data Presentation & Visual Literacy in Medicine and Science – Simmonds D, Reynolds L – Newton, MA, USA – Butterworth-Heinemann – 1994

September 2008

2008

01-Aug-2007

2006

01-Jul-2008

20-Feb-2003

2005

1998

27-Nov-2003

June 2007

1994

R30. Designing Instructional Text – Hartley J – London, Kogan Page Third Edition, 1994

R31. Drug selection errors in relation to medication labels: a simulation study – Garnerin et al – Anaesthesia 2007, 62, pages 1090-1094

R32. NHS NPfIT – Types of medication item for display and prescribing within Secondary Care electronic systems – NPfIT-EP-DB-0022.01

Table 8: References

2007

2008

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APPENDIX A REFERENCE SUMMARY OF GUIDANCE

MEDi-001 to MEDi-003, MEDi-013 Visual Summary:

Col1	generic	brand

diltiazem– CALCICARD CR – modified-release tablet – `DOSE` 120 mg – oral – twice a day	diltiazem– CALCICARD CR – modified-release tablet – `DOSE` 120 mg – oral – twice a day	diltiazem– CALCICARD CR – modified-release tablet – `DOSE` 120 mg – oral – twice a day

MEDi-001 3.3.1 Display generic drug names in bold

MEDi-002 3.3.1 Display generic drug names in lowercase (capital letters may still be used for acronyms and abbreviations in some drug names such as amphotericin B, factor VIII, carbomer 974P)

MEDi-003 3.3.1 Display drug brand names in uppercase

MEDi-013 3.3.1 Where both the generic name and the brand name appear in a medication line, list the generic name first

MEDi-014 to MEDi-017 Visual Summary:

MEDi-014 3.3.2 Where possible, avoid the need for decimal points by changing the units without breaking convention

MEDi-015 3.3.2 Do not put a trailing zero after a sub-decimal value (that is, ‘0.5’ is correct but ‘0.50’ is incorrect)

MEDi-016 3.3.2 Put a leading zero before a decimal point for values of less than one

MEDi-017 3.3.2 Use a comma to break up numeric values of one thousand and above

MEDi-018 to MEDi-020 Visual Summary:

MEDi-018 3.3.3 When combining attributes in a text string, use a long dash (em dash) surrounded by spaces between the attributes

MEDi-019 3.3.3 Use a double space instead of a long dash or separator between a drug name and strength when there are multiple drug names in one medication line

MEDi-020 3.3.3 Use a double space instead of a long dash or separator between a drug name and strength when the strength is expressed as a percentage

MEDi-010, MEDi-011, MEDi-021, MEDi-008 Visual Summary:

MEDi-010 3.3.4 When wrapping the text of a medication line, do so without breaking up the contents of a single attribute unless that single attribute will not fit on one line

MEDi-011 3.3.4 When wrapping the text of a medication line, keep trailing delimiters with the preceding attribute

MEDi-021 3.3.4 If a long drug name exceeds the available screen space and has to be wrapped, ensure that the drug name is wrapped between words

MEDi-008 3.3.4 Do not allow wrapping to separate a label from a value

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MEDi-022 to MEDi-024 Visual Summary:

Do not abbreviate drug names

MEDi-022 3.3.5 Do not abbreviate drug names

MEDi-023 3.3.5 Use long form names rather than abbreviations or symbols where possible

MEDi-024 3.3.5 Do not put a full stop after abbreviations for units (for example, mg and mL)

MEDi-025, MEDi-012 Visual Summary:

Col1	i

heparin– 5,000 units per mL – solution for in	heparin– 5,000 units per mL – solution for in

Do not truncate or omit information from a medication line

MEDi-025 3.3.6 Do not truncate drug names

MEDi-012 3.3.6 If necessary, wrap but do not truncate medication line information

MEDi-054 3.3.6 Do not display a part of the medication line alone if its meaning relies on other parts that are not displayed

MEDi-026 to MEDi-028 Visual Summary:

@ & | / \ < > ( ) [ ] { }

MEDi-026 3.3.7 Do not use symbols that may be confused with numbers or otherwise misinterpreted, including: @ | <

             - / \ & ° (at sign, vertical bar, greater than bracket, less than bracket, forward slash, backslash,

ampersand, degree)

MEDi-027 3.3.7 Use the ‘+’ (plus symbol) only for multiple drug name medications and surround it with spaces. When a ‘+’ is displayed adjacent to a ‘4’, separate the two with a double space

MEDi-028 3.3.7 Use alternatives such as a dash or a black dot ( ● ) instead of brackets and separators such as ( ) [ ] { } that look like the number one

MEDi-009, MEDi-029 to MED-034 Visual Summary:

MEDi-009 3.3.8 Use a different font and colour to differentiate labels from values

MEDi-029 3.3.8 When a medication is represented as a single-text sentence, use a label for dose only

MEDi-030 3.3.8 When a medication is represented as a series of lines with hard line breaks, labels should appear at the beginning of a new line after a hard line break

MEDi-031 3.3.8 Use a space to separate a label from a value

MEDi-032 3.3.8 Do not use a colon after a label

MEDi-033 3.3.8 Display labels in uppercase

MEDi-034 3.3.8 Keep the number of text labels in a medication represented as a single-text sentence to a minimum

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MEDi-035 Visual Summary:

Col1	line b

paracetamol – tablet `DOSE` 500 mg – oral – every 6 hours text wrap	paracetamol – tablet `DOSE` 500 mg – oral – every 6 hours text wrap

MEDi-035 3.3.9 When using hard line breaks at set points (such as before a dose), do not use a long dash at the end of the previous line

MEDi-036, MEDi-037 Visual Summary:

Preserve white space between lines

Col1	Col2	Col3
	paracetamol –
	tablet –
	`DOSE` 500 mg –
	oral – every 6 hours

MEDi-036 3.3.10 When displaying a medication as one or many lines of text, preserve white space between the lines by ensuring that the line height is no less than 120% (120% leading) and no greater than 140% (140% leading)

MEDi-037 3.3.10 When displaying a list of medications, ensure that there is a space equivalent to at least one line height of 100% between the last line of one medication line and the first line of the medication line below

MEDi-007, MEDi-038 to MEDi-044 Visual Summary:

Col1	label	spac

`DOSE` 500 mg	`DOSE` 500 mg	`DOSE` 500 mg

Col1	bold

`DOSE` 500 mg	`DOSE` 500 mg

MEDi-007 3.3.11 Provide a text label that reads ‘DOSE’ before a dose

MEDi-038 3.3.11 Display the dose amount and units in bold

MEDi-039 3.3.11 When a dose is expressed as a volume, display the volume amount in bold

MEDi-040 3.3.11 When there is no dose or volume, display a dose equivalent in place of the dose and subject to the same guidance points as a dose. Precede with an appropriate text label

MEDi-041 3.3.11 Separate the dose amount from the dose units with a space

MEDi-042 3.3.11 Do not put a trailing zero after a sub-decimal value when displaying a dose amount (that is, ‘0.5’ is correct but ‘0.50’ is incorrect)

MEDi-043 3.3.11 Put a leading zero before a decimal point for values of less than one when displaying a dose value

MEDi-044 3.3.11 Use a comma to break up numeric values of one thousand and above when displaying a dose value

MEDi-045 to MEDi-050 Visual Summary:

MEDi-045 3.3.12 When describing strengths with an active ingredient in a fluid, use ‘in’ rather than a forward slash ( ‘/’ ) before the fluid quantity

MEDi-046 3.3.12 When describing strengths of an ingredient in a single unit of fluid, use the word ‘per’ to describe the unit of fluid

MEDi-047 3.3.12 When describing a strength for a combination drug whose two strength values use the same unit (such as mg), use the word ‘and’ in a smaller font to join the two strength values and display the units after the second strength value

MEDi-048 3.3.12 Do not put a trailing zero after a decimal point when displaying numbers in a strength value

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MEDi-049 3.3.12 Put a leading zero before a decimal point for values of less than one when displaying numbers in a strength value

MEDi-050 3.3.12 Use a comma to break up numeric values of one thousand and above when displaying numbers in a strength value

MEDi-051 to MEDi-053 Visual Summary:

generic - BRAND – strength – form – DOSE dose - route – frequency

MEDi-051 3.3.13 When describing a medication as a line of text, adhere to the following order for the display of the medication attributes: drug name, brand name, strength, form, dose or volume, rate, dose duration, route, frequency (as applicable)

MEDi-052 3.3.13 When designing for specific contexts, especially those that need additional text labels and line breaks, display drug name first and display other attributes (in a different order if necessary) from the one defined above

MEDi-053 3.3.13 When a medication is not displayed as a single line of text and the attributes of a medication are listed in a different order, use text labels for as many of these attributes as possible: strength, form, route and frequency

Table 9: Reference Summary of Guidance

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REVISION AND SIGNOFF SHEET

Change Record

28-Jul-2008 Sarah Parker 0.0.0.1 Initial draft for review/discussion

10-Sep-2008 Sarah Parker 0.0.0.2 Revised draft for second review

16-Sep-2008 Niki Nicolaides 0.0.0.3 Initial copyedit

30-Sep-2008 Sarah Parker 0.0.0.4 Responses to copyedit

01-Oct-2008 Sarah Parker 0.0.0.5 Guidance updated in response to technical feedback and user research findings

03-Oct-2008 Mick Harney 0.0.0.6 Remaining questions for Sarah after copyedit

03-Oct-2008 Sarah Parker 0.0.0.7 Updates in response to Mick’s questions. A few questions remain.

06-Oct-2008 Mick Harney 1.0.0.8 Restored correct versioning. Last few points to agree with Sarah.

07-Oct-2008 Sarah Parker 1.0.0.9 Updates in response to Mick’s questions. One last point to resolve.

07-Oct-2008 Mick Harney 1.0.1.0 Raised to Working Baseline

23-Oct-2008 Sarah Parker 1.0.1.1 Updates in response to CRS

23-Oct-2008 Mick Harney 1.0.1.2 Copyedit of updates: final points to check.

23-Oct-2008 Sarah Parker 1.0.1.3 Final points updated

29-Oct-2008 Mick Harney 1.1.0.0 Raised to Baseline Candidate

06-Nov-2008 Mick Harney 2.0.0.0 Raised to Baseline

Document Status has the following meaning:

Drafts 0.0.0.X - Draft document reviewed by the Microsoft CUI Project team and the

Authority designate for the appropriate Project. The document is liable to change.

Working Baseline 0.0.X.0 - The document has reached the end of the review phase and

may only have minor changes. The document will be submitted to the Authority CUI Project team for wider review by stakeholders, ensuring buy-in and to assist in communication.

Baseline Candidate 0.X.0.0 - The document has reached the end of the review phase and

it is ready to be frozen on formal agreement between the Authority and the Company

Baseline X.0.0.0 - The document has been formally agreed between the Authority and the

Company

Note that minor updates or corrections to a document may lead to multiple versions at a particular status.

Open Issues Summary

None

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Audience

The audience for this document includes:

Authority CUI Manager / Project Sponsor . Overall project manager and sponsor for the

NHS CUI project within the Authority.

Authority Clinical Applications and Patient Safety Project Project Manager.

Responsible for ongoing management and administration of the Project.

The Authority Project Team . This document defines the approach to be taken during this

assessment and therefore must be agreed by the Authority.

Microsoft NHS CUI Team . This document defines the approach to be taken during this

assessment, including a redefinition of the Clinical Applications and Patient Safety Project strategy.

Reviewers

Mike Carey Workstream Lead

Tim Chearman UX Architect

Peter Johnson Clinical Architect

Ann Slee Clinical Lead for e-Prescribing

Beverley Scott Clinical Safety Advisor

Dee Hackett Clinical Advisor

Mark Wills Clinical Advisor

Distribution

Mike Carey Workstream Lead

Tim Chearman UX Architect

Peter Johnson Clinical Architect

Ann Slee Clinical Lead for e-Prescribing

Beverley Scott Clinical Safety Advisor

Dee Hackett Clinical Advisor

Mark Wills Clinical Advisor

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Document Properties

Document Title Medications Management – Medication Line User Interface Design Guidance

Author Clinical Applications and Patient Safety Project

Restrictions RESTRICTED – COMMERCIAL; MICROSOFT COMMERCIAL; Access restricted to: NHS CUI Project Team, Microsoft NHS Account Team

Creation Date 22 July 2008

Last Updated 23 June 2015

Copyright:

You may re-use this information (excluding logos) free of charge in any format or medium, under the terms of the Open Government Licence. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence or email psi@nationalarchives.gsi.gov.uk.

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