It’s well known that instructions on medication (both prescription and otherwise) can be confusing and lead to potentially lethal consequences. (See our previous blog on the topic.) Now imagine how much more danger there is if you don’t speak the language in which the instructions are printed.
A recent study published in the American Academy of Pediatrics Journal “evaluated the accuracy of translated Spanish-language medicine labels among pharmacies in a borough with a large Spanish-speaking population. ” The study found significant issues with label accuracy with a popular language in an area with a large population of speakers of that language. You can imagine how these results could get even worse for an area that had a smaller number of Spanish speakers, or for patients who speak a less common language.
One of the most striking examples was a man who received heart medication that was to be taken once daily. The instructions were only partially translated and “once” (which means 11 in Spanish) was left on the instructions. The patient took 11 pills (instead of 1) a day.
The study found an overall error rate of the prescription instructions that had been translated into Spanish by computer of 50%. (86% of the pharmacies surveyed translated their prescriptions with a computer program.) It is likely that patients with the incorrectly translated prescription instructions took the medicine incorrectly, resulting in the potential for serious harm, or even death. This is an impact to the patient safety goal. The rate of errors made by the computer means more work for pharmacists and translators due to the corrections that must be (or should be) made. (Obviously this is not always happening.) Patients receiving instructions they do not understand can be considered an impact to the patient services, compliance, and organizational goals. (The study was performed in the Bronx, New York. It is a law in New York City for pharmacy chains to provide translated labels for the top seven foreign languages in the area.)
Patients do not understand the directions because the patients do not speak English and the instructions are either not translated, or are translated incorrectly. The instructions may be translated incorrectly because the computer program translates them incorrectly and there is an inadequate verification of the computer translation, because the pharmacist does not speak the language and/or there is no translator available (likely due to lack of funds or an uncommon language). The instructions may not be translated if the pharmacy has no translating capabilities, also likely due to cost or an uncommon language.
An obvious suggestion is to improve the accuracy of the computer programs that do the translating, perhaps standardizing the translations among the different programs that do the job. Pharmacists could also be provided with a guidebook of translations for standard pharmacy terms (such as take orally). Additionally, translation software could be added to the computer programs currently used by pharmacists.
I have a simpler suggestion that I borrowed from the aviation industry. I noticed the last time I flew that instead of having translations of the safety instructions in a dozen different languages, there were practically no words at all. Instead, the airline used picture instructions. I suggest doing something similar with medications. (See my example of a picture for “take orally” on the PDF. View the root cause analysis investigation and my picture by clicking “Download PDF” above.)
Because of the risk involved, it’s clear something needs to be done. Prescription instructions are hard enough to understand in English, much less poorly translated into another language. I’m sure suggestions will keep coming in, and surely some smart folks out there will come up with a way to reduce the potential for confusion and injury.