Take-Wait-stop: A Patient-Centered Strategy for Writing PRN Medication Instructions

Abstract

Recent studies have linked patient misunderstanding of label instructions for as needed (PRN) medications to dosing errors. This study conducted a preliminary field test of patient-centered PRN label instructions. Patients participated in a hypothetical dosing experiment and were randomized to a patient-centered label (referred to as “Take-Wait-Stop”) or standard label. Participants were asked to demonstrate dosing the medicine over 24 hours. Three types of independent dosing errors were measured: (a) taking more than two pills at one time, (b) exceeding the maximum daily dose, and (c) waiting fewer than 4 hours between doses. Generalized linear models were used to assess the association between label type, health literacy, and sociodemographic characteristics. Participants' mean age was 39.8 years, 62.1% were female, 43.7% were White, and 72.4% had adequate literacy. Of participants, 31.8% who were shown the standard label demonstrated taking in excess of 6 pills in 24 hours compared with only 14.0% of participants who were shown the Take-Wait-Stop label (p = .05). Overall, only 1 person demonstrated he would take more than 2 pills in a single dose. Of the standard label group, 20.5% demonstrated dosing intervals of fewer than 4 hours compared with 23.3% of the Take-Wait-Stop label group (p=.75). In a multivariate model, participants who were exposed to the standard label were 2.5 times more likely to exceed the recommended maximum daily dose (95% CI [1.05, 7.70], p=.03). The Take-Wait-Stop label was beneficial in preventing participants from exceeding the maximum dose in 24 hours, although it did not significantly reduce other dosing errors.

Acknowledgments

Jennifer P. King, Rebecca J. Mullen, Marina Serper, and Kara L. Jacobson have worked on projects funded by unrestricted research grants from McNeil Consumer Healthcare. Danielle M. McCarthy has received unrestricted grant funding from the Emergency Medicine Foundation in conjunction with Purdue Pharma and has worked on projects funded by unrestricted research grants from McNeil Consumer Healthcare. Terry C. Davis received unrestricted research grant funding from McNeil Consumer Healthcare and the Abbott Foundation and has served as a paid consultant to McNeil Consumer Healthcare. She owns stock in Abbott and Johnson & Johnson. Stacy C. Bailey has worked on an unrestricted research grant funded by McNeil Consumer Healthcare and has served as a paid consultant to Abbott Laboratories. Ruth M. Parker has received unrestricted research grant support from McNeil Consumer Health, Johnson & Johnson, the Abbott Foundation, and McKing Consulting; none of this support is a source of a conflict of interest. Michael S. Wolf has received unrestricted research grant funding from McNeil Consumer Healthcare and Abbott Foundation, and has served as a paid consultant to McNeil Consumer Healthcare, Abbott Laboratories, and Earthbound LLC.