What is Tall-Man Lettering?

Medication Safety

Medication safety is important – one of the most tested subjects on the PTCB exam. Students must understand what techniques – such as tall-man lettering – are used to limit the possibility of medication error.

Medication errors are all too common.

There are approximately 1.25 million medication errors in the United States each year. Research suggests that 77 percent of these errors are avoidable. Even with the intense training that healthcare professionals receive, errors continue to come forward and place significant risks to the lives of many patients. Medical errors of all kinds kill up to 100,000 Americans each year and is now the eighth leading cause of death.

One of the compounding factors that lead to errors is down to the sheer number of drugs and medicines available. Because of the vast array of drugs, it is inevitable that some medicines will sound alike. And if they sound alike, it becomes far easier to choose the wrong medicine to dispense to the patient. There are several ways of reducing the risk of these kinds of medication error.

Strategies to Reduce Medication Error

There are two kinds of measures – medication safety measures instituted by pharmacies or organizations, and prevention strategies introduced by the ISMP – the Institute for Safe Medication Practices. As a prospective pharmacy technician, you should have a thorough knowledge of all strategies used to reduce medication error.

Institutions may implement strategies such as:

• Bar-coding both the patient and the medicine to ensure that a correct match is always made before the medicine is dispensed.
• Using the NDC number for the drug to reinforce the selection of the right medicine.

The ISMP has introduced a list of medicines which look-alike and sound-alike – what are called LASA name pairs.

Here are some common examples:

Drug / Medicine Name	Confused Drug / Medicine Name
Acetaminophen	Acetazolamide
Adderall	Inderal
Lamotrigine	Lamivudine
Lente	Lantus
Quinine	Quinidine
Rifampin	Rifaximin
Tizanidine	Tiagabine
Trazodone	Tramadol
Vioxx	Zyvox
Zantac	Xanax

One of the recommended methods to avoid choosing the wrong medicine is to enact tall-man lettering.

What is tall-man lettering?

Tall-man lettering refers to the practice of using capital letters on part of a drug or medicine name to help differentiate it from a similarly sounding/looking drug or medicine.  

There are two kinds of tall-man lettering – those recommended by the FDA and those recommended by the ISMP.

For example:

• prednisoLONE and predniSONE
• ALPRAZolam and LORazepam
• HYDROcodone and oxyCODONE
• PARoxetine and FLUoxetine
• traMADol and traZODone

As you can see with these examples, capital letters are used to highlight the most significant difference between the two drugs or medicines to make their names easily identifiable and distinguishable from one another.

This is an effective medication safety strategy that can significantly reduce the risk of error.

Of course, tall-man lettering must be used in conjunction with other medication safety strategies. These include the use of bar codes, NDC codes, using and verifying both the medicine and active ingredient name on labels, and limiting the use of error-prone prescription abbreviations.

Taken together, all these strategies can have a marked reduction in medication error and increase the prospect of patient safety.

Check back to PTCB Test Prep soon for more on medication safety, PTCB practice test questions, and more to help you master the 2020 PTCB exam.