Approved by: Tall Man Lettering Vice President and Chief Medical Officer; and Vice President and Chief Operating Officer Corporate Policy & Procedures Manual Number: VII-B-340 Date Approved November 23, 2017 December 8, 2017 Next Review (3 years from Effective Date) December 2020 NOTE: The first appearance of terms in bold in the body of this document (except titles) are defined terms please refer to the Definitions section. Purpose To ensure that Tall Man lettering is used to identify medications that may be easily mistaken with medication with similar names and to provide standards for the use of Tall Man lettering in all computer generated medication related documentation. Policy Statement Covenant Health shall align with the Alberta Health Services (AHS) Tall Man lettering list approved and maintained by the AHS Medication Quality and Safety Team (MQST) to reduce risks associated with similar looking medication names. Applicability This policy and procedure applies to all Covenant Health facilities, staff, members of the medical staff, volunteers, students and any other persons acting on behalf of Covenant Health. Exception: Contracted community pharmacies whose software is unable to accommodate the Tall Man lettering. Responsibility The Covenant Health Medication Management Safety Team (MMST) shall be responsible for reviewing requests to add a medication to the Tall Man lettering list, and revising the Tall Man lettering list, in collaboration with the AHS MQST. Principles Certain medication names can appear very similar and are described as read-alike or look-alike. Look-alike medication names can contribute significantly to medication errors. Organizations such as the Institute for Safe Medication Practices (ISMP) and the US Food and Drug Administration (FDA) have recommended the use of Tall Man lettering as one method to reduce the risks associated with similar looking medication names. Tall Man lettering shall only be applied to medication names that appear on the approved list (Appendix A). Tall Man lettering shall be incorporated into pharmacy computer systems, automated dispensing systems, and computerized physician order entry systems. Tall Man lettering shall be applied within pharmacy and patient care units, including but not limited to: labelling of medication storage containers labelling of repackaged or compounded medications
VII-B-340 Page 2 of 6 medication naming within automated dispensing machines (i.e. Pyxis) site specific worksheets or forms (including controlled substance logs) pre-printed medication order sets (PMOS) provincial parenteral monographs provincial medication formulary Procedure 1. Requests to add medications to the list, for review or to provide feedback on the Tall Man Lettering list is done by completing the Pharmacy Services Tall Man Lettering Request and Feedback form (Appendix B), and should include relevant background information and rationale. 2. Send the completed form to the site Pharmacy Manager. 3. Pharmacy Managers will review and forward the completed form to the Covenant Health Medication Management Safety Team (MMST). 4. MMST will review the requests and work with the AHS MQST to implement any changes to the Tall Man lettering list (Appendix C). Definitions Tall Man Lettering means a typographic technique that utilizes selective capitalization of certain letters to help differentiate between similar looking medication names. References Alberta Health Services Tall Man Lettering Policy, number 4.01.04. April 17, 2013 Alberta Health Services Pharmacy Services Tall Man Lettering List Appendix. July 13, 2015 Gerrett D, Gale AG, Darker IT, Filik R, Purdy KJ. Tall man lettering. Final report of the use of tall man lettering to minimize selection errors of medicine names in computer prescribing and dispensing systems. Loughborough University Enterprises Ltd.; 2009 (www.connectingforhealth.nhs.uk/systemsandservices/eprescribing/refdocs/tallman.pdf). ISMP Canada Safety Bulletin. Application of Tallman Lettering for Drugs in Oncology. Volume 10, Number 8. November 11, 2010 Previous Version Date(s) December 6, 2013
VII-B-340 Page 3 of 6 APPENDIX A The list below was developed by AHS Pharmacy Services Medication Quality and Safety Team, and has been approved for use within Covenant Health. Date approved/revised July 13, 2015 Pharmacy Services Tall Man Lettering List acetazolamide acetohexamide ALPRAZolam amiloride amlodipine ARIPiprazole azacitidine azathioprine AZIthromycin bisacodyl bisoprolol BUPivacaine bupropion buspirone captopril carbamazepine CARBOplatin carvedilol cefaclor cefazolin cefepime cefixime cefotaxime cefotetan cefoxitin cefprozil ceftazidime ceftizoxime ceftriaxone cefuroxime cephalexin chlordiazepoxide chlorpromazine chlorpropamide CISplatin clobazam clomiphene clomipramine clonazepam clonidine clozapine cycloserine cyclosporine DAPTOmycin DAUNOrubicin dimenhydrinate diphenhydramine dobutamine DOCEtaxel dopamine DOXOrubicin DULoxetine ephedrine epinephrine fentanyl flavoxate fluconazole flucytosine FLUoxetine fluphenazine fluvoxamine GLICLAzide glipizide glyburide guaifenesin guanfacine
HumaLOG HumuLIN hydralazine HYDROmorphone hydroxyurea hydroxyzine IDArubicin imatinib infliximab ISOtretinoin lamivudine lamotrigine LORazepam medroxyprogesterone metformin methylprednisolone methyltestosterone metolazone metoprolol metronidazole mitoxantrone nicardipine nifedipine nimodipine NovoLIN NovoLOG OLANZapine OXcarbazepine oxycodone PACLitaxel PARoxetine phenobarbital PHENYLephrine phenytoin prednisolone prednisone QUEtiapine quinidine quinine RABEprazole rifabutin rifampin rituximab ROPivacaine SAXagliptin SITagliptin SORAfenib SUFentanil sulfadiazine sulfasalazine sulfisoxazole SUNItinib tiagabine tizanidine tolazamide tolbutamide tramadol trazodone valacyclovir valganciclovir vinblastine vincristine VII-B-340 Page 4 of 6
VII-B-340 Page 5 of 6 Appendix B Pharmacy Services Tall Man Lettering Request and Feedback Form Please complete this form for any requests, comments or questions you may have regarding Tall Man lettering. In addition, revisions to the Pharmacy Services Tall Man Lettering List may be requested via completion and submission of this form. Date: Requestor Information: Contact Name: Phone #: Site: Email: Pair: Background information and rationale for request, including any medication error reports: Comments/Questions? Submit completed form to your site Pharmacy Manager. Once reviewed by the Pharmacy Manager the completed form is submitted to Covenant Health Medication Management Safety Team at: Medication.Managment@covenanthealth.ca
VII-B-340 Page 6 of 6 APPENDIX C