In March, 2008, in an effort To help the 20 million people with vision loss properly identify prescription medications, the American Society of Consultant Pharmacists (ASCP) Foundation joined forces with the American Foundation for the Blind (AFB) to develop "Guidelines for Prescription Labeling and Consumer Medication Information (CMI) for Persons with Vision Loss." The Guidelines provided pharmacists and pharmacies with specific recommendations for making important medication information accessible to patients with vision loss and have served as a resource for persons with vision loss and organizations serving this population since that time.
Access to prescription information, including drug labels and usage instructions, is essential for the correct taking of medication. For individuals with vision loss, not being able to read this information is a particularly dangerous problem. Currently, people with vision loss must rely on memory, use compensatory strategies or devices, or depend on someone else for help. As a result, many people with vision loss and older adults with reduced visual acuity are unable to "access" important instructions for use and safety information from prescription labels and CMI.
"The lack of accessible prescription and over-the-counter medication label information poses a serious public health threat due to the potential misidentification and misuse of drugs," said Judy Scott, Director of the AFB Center on Vision Loss. "These guidelines have had the potential to help consumers with vision loss access the vital information on medication labeling, enabling them to take medications safely, effectively, and independently."
The ASCP Foundation and AFB convened an advisory board, comprised of individuals from vision loss organizations, government, pharmacy, and pharmacy system vendors , to identify components of the Guidelines and specific format recommendations.
In addition to specific format recommendations for prescription labeling and CMI, the Guidelines that were developed also provided suggestions for making information accessible to people for whom larger print is not useful and general information on assistive technology, resources, and services that pharmacists and pharmacies can share with their patients with vision loss. The full guidelines are available at www.ascpfoundation.org, and an abbreviated list is below.
This project was funded by the American Foundation for the Blind, American Society of Consultant Pharmacists Foundation, and a vendor contract from Pfizer Inc.
The ASCP Foundation is the research and education affiliate of the American Society of Consultant Pharmacists (ASCP). The ASCP Foundation has a proven track record of developing practical interventions for improving medication use in the senior population. The mission of the ASCP Foundation is to foster appropriate, effective, and safe medication use in older persons. The unique focus of the ASCP Foundation is the development, integration, and application of knowledge regarding medication use in the senior population and the practice of senior care pharmacy to optimize health outcomes. The ASCP Foundation has a history of leadership, innovation, and expertise in medicines and aging and has collaborated with numerous organizations to address the information and education needs of consumers, families, caregivers, health care professionals, and the aging network regarding medication use. Visit the ASCP Foundation's web site at www.ascpfoundation.org.
The American Foundation for the Blind (AFB) is a national nonprofit that expands possibilities for people with vision loss. AFB's priorities include broadening access to technology; elevating the quality of information and tools for the professionals who serve people with vision loss; and promoting independent and healthy living for people with vision loss by providing them and their families with relevant and timely resources.
This consumer flyer has been widely distributed to consumers since 2008.
Are You Having Trouble Reading Prescription Labels?
Ask your pharmacist to consider these guidelines:
Contrast:
Text should be printed with the highest possible contrast.
Use black letters on white or pale yellow background.
Avoid the use of red, yellow, or blue type and backgrounds other than white or yellow.Paper Finish:
Paper with a glossy finish can lessen legibility because of glare
Use uncoated paper/label stock.
Do not cover prescription label with reflective tape, which may cause glare.Case: Use upper and lower case, rather than ALL CAPS.
Font Family:
Sans Serif fonts are fixed-stroke width fonts providing consistent letter contrast to aid reading acuity and efficiency.
Use sans serif font, such as Arial, Verdana, or APHontTM. APHontTM was developed specifically for low vision readers and embodies characteristics that have been shown to enhance reading speed, comprehension, and comfort for large print users. Available free at www.aph.org/products/aphont.html.Letter spacing: Use standard spaced fonts, not narrow or condensed
Type Style:
Use bold typeface for the most important information on prescription labels and CMI.
Do not use italic, oblique, or condensed type.Leading (spacing between lines of text): Font size plus 30%; 24 pt leading for 18 pt font. Alternative: 1.5 lines between text.
Type Size: Use minimum 18-point type. Note: There may be patients who require larger font size for readability, or for whom large print is not useful.
Format CMI:
Use single column, left justified text.
Minimum one inch margins.
Avoid bullet points; instead left justify text and use extra spacing between lines to differentiate between points and sections.
Make meaningful headings boldface in larger font.
Bold critical portions of narrative sections within text.
Provide a summary of most critical points for quick reference.
Five Simple Solutions for Managing Your Medications:
1. Ask your pharmacist to print an auxiliary label with larger print that you can easily see. Then mark your medication bottles with large print labels, tactile dots, rubber bands or Braille.
2. Try talking medication identifiers if large print labels don’t work for you.
3. Using a tray with good contrast helps with seeing your pills and keeps them from falling on the floor if dropped.
4. Using good task lighting can also help if positioned closely to the labels you are trying to see.
5. Attach daily dosage trackers to medication bottles to help you remember if you have taken each dose of a particular medication each day.
Although these 5 year old guidelines are a viable place from which to begin the conversation about best-practices for accessible medication labeling, they do not address many remaining important issues. Individuals with vision loss are just that, individuals, and therefore they have individual needs. What works for one will not work for the next, so awareness of finding appropriate solutions for each patient is paramount. Maintaining independence, privacy and safety cannot be ignored for any individual. If a talking product is a better solution for a patient than large print or braille, steps to make sure the speech is understandable by that person, use of the equipment is possible for that person and maintaining the device is feasible for that person. With audio devices, privacy must be considered. An individual may not want everyone within earshot to know what medication they are taking and if they are reluctant to use the device to protect their privacy, the effectiveness of the solution to label access is lost. It is possible that seniors will have a difficult time understanding synthesized speech such as that produced by ScripTalk, but a human voice recording device such as Tel-RX has inherent problems as well. When being recorded, human error is a factor and clear speech and pronunciation may also be problematic. These considerations and many others with each product now available and those to be developed in the future must be considered on an individual basis. Awareness at the patient, pharmacist and physician level is vital. If a person with low or no vision has difficulty accurately measuring liquid medication for themselves or their dependent, consideration must be given to alternatives, even if they are more costly, without penalty to the individual with vision loss. It is essential that a variety of possible solutions be presented, explored and considered for each patient. An informed decision that does not consider cost or convenience to the provider must be made by each individual customer.