Regs’n’drugs

Finding it difficult to tell how much sugar or salt is in a grocery item picked from a supermarket’s shelves can be frustrating. It can even have health implications for consumers who suffer from diabetes, or those trying to lose weight. But there is a category of products where confusion over ingredients can have far more serious implications. It is also one where mistakes, if they are made, often happen before the customer even touches the product: medicines.

Medicines are invariably dispensed to consumers by a pharmacist. These busy professionals must select the right products every time, despite similar-sounding names often rooted in Latin. They must be aware of products that cannot be used with certain others. They must cope with scrawled handwriting on prescriptions. They might also be coping with hard-of-hearing pensioners, noisy children and heroin addicts arriving for their daily dose of methadone, all at the same time.

Some now fear that confusing packaging design is making their task more difficult. ‘One of the problems is that brand design can confuse. Manufacturers tend to put all their packaging in the same house style so that it will stand out on the shelf as being from that brand,’ says Roger Odd, trustee of The Patients Association. ‘But the contents are different medicines, or in different strengths.’

While a strong corporate identity can benefit the brand, it makes things harder for pharmacists and patients, says Odd, especially for those with long-term conditions which need constant medication. ‘Patients need different packs, too, as they can make mistakes if they are using up to eight products a day,’ he says. ‘We saw a case where a nurse administered the wrong medicine through an intravenous drip, because the packaging was very confusing.’

The differences between branded and generic drugs can also cause confusion among patients. Typically, if a pharmaceutical company develops a new medicine it will have exclusive rights to produce it for a period. After this, other companies are able to manufacture generic versions of the drug using its medical name, as opposed to the brand name given by the developer. ‘People sometimes don’t understand the generic name,’ says Odd.

Andy Knowles, chief executive of packaging group JKR, says that medicine packaging works hard to get its message across using simple methods. ‘You have to keep in mind that, often, the people taking the medicines are almost in a trance,’ he says of patients who are taking a virtual cocktail of drugs three times a day. The routine nature of medicine use makes it a low engagement activity, he says. ‘What can packaging do to improve that? Within reason, not much more than it does now,’ adds Knowles.

The Medicines and Healthcare products Regulatory Agency insists clear labelling is essential to avoid errors, saying the primary purpose of medicine packaging and labelling is the ‘clear and unambiguous’ identification of products and the conditions for their use.

In the MHRA’s guidelines it concedes that similarity in packaging is known to contribute to medication errors. They state specifically what items of information should be on packaging, stipulating that these items should be in the same field of view and not ‘broken up by additional logos or background text or graphics’.

Whether or not this is providing sufficient support for those who administer medicines might be a subject for debate. It has been reported that confusing packaging causes a third of the medication errors logged within the NHS.

There has been additional pressure this year to review confusing packaging, from patients and pharmacists. Because of a quirk of the Medicines Act 1968, pharmacists who dispense incorrect medicines are committing a criminal offence, and can be prosecuted. The case of locum pharmacist Elizabeth Lee hit the headlines last year, when she was given a suspended prison sentence after mistakenly giving beta blockers, instead of steroids, to a 72-year-old patient who died shortly after taking the pills.

While pharmacists would like to see changes in the way dispensing errors are dealt with, they are also justifiably anxious that a genuine mistake could land them in the dock. It is very difficult to imagine a packaging designer joining them there, even if packaging may have contributed to the error.