prescriptions clearly and to ensure that appropriate information is given to patients; ultimately, these are skills that should be included in the medical school curriculum.

Drug labels need to be made much simpler. An important partner in determining how to move forward in this process is the National Association of Boards of Pharmacy.


Director of Pharmacy Systems, Wal-Mart

An expected benefit of standardization is consistency. Clearly there is now great inconsistency across pharmacies. As Wolf stated when describing the 31 different label styles developed in response to state regulations, there is great disparity in minimal requirements. It is to the benefit of a chain such as Wal-Mart that as much information as possible is presented in a consistent manner.

However, there are barriers and limitations to standardization. One barrier is the opportunity costs of standardization. That is, if improvement efforts are focused on standardization, it could result in not implementing other approaches to reducing medication errors that might have a bigger effect on consumer health and well-being. Another concern relates to adopting a standard that requires placing the indication for the medication on the label. Some patients may not wish such information displayed on the label—for example, patients who are being treated for depression or erectile dysfunction. In determining the information that should appear on a label, the patient’s perspective should be considered.

There are some advantages to unit-of-use packaging such as the Z-Pak (Zithromax­®) developed by Pfizer. For example, regardless of what the physician writes on the prescription or what the pharmacy provides the patient when it dispenses the medication, necessary information is consistently presented on the Z-Pak itself, including what the medication is for and how to take it. The packaging also includes the lot number and expiration date, which would be of great value if a Class I recall was issued.

Wal-Mart is examining the possibility of placing generic medication in a package similar to that of the Z-Pak, always being cognizant of current FDA restrictions, and is working with the generic manufacturers to accomplish this. The approach was tested with Warfarin. Consumers were presented with the medication in what is called consumerized prescription packaging. The responses were very positive.

An examination of the current evidence seems to support standardization of drug labels as a mechanism for increasing patient com-

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