{{Short description|Practice of writing part of a drug's name in upper case letters}} [[File:Dopamine HCl.JPG|thumb|A vial of [[dopamine (medication)|dopamine]], labeled as "DOPamine HCl"]] '''Tall man lettering''' ('''tall-man lettering''' or '''tallman lettering''') is the practice of writing part of a [[drug]]'s name in [[upper case]] letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors.<ref name=FDA>{{cite web| url= https://www.fda.gov/cder/drug/MedErrors/nameDiff.htm |publisher= Center for Drug Evaluation and Research, U.S. Food and Drug Administration| website= FDA.gov | title= Name Differentiation Project| archiveurl= https://web.archive.org/web/20080221164437/https://www.fda.gov/cder/drug/MedErrors/nameDiff.htm| archivedate= February 21, 2008| url-status= dead |access-date= January 10, 2022}}</ref><ref name=ISMP>{{cite web| url= http://www.ismp.org/faq.asp#Question_5 |website= ISMP.org| publisher= [[Institute for Safe Medication Practices]] |title= FAQ: 5. How should Tallman lettering be applied to look-alike/sound-alike drug name pairs?| url-status= dead| archiveurl= https://web.archive.org/web/20071218023454/https://www.ismp.org/faq.asp#Question_5| archivedate= December 18, 2007| access-date= January 10, 2022}}</ref> For example, in tall man lettering, "[[prednisone]]" and "[[prednisolone]]" should be written "predniSONE" and "predniSOLONE", respectively. The Office of Generic Drugs of the US [[Food and Drug Administration]] (FDA) encourages [[Pharmaceutical company|manufacturers]] to use tall man lettering labels to visually differentiate their drugs' names,<ref name=FDA/> and a number of hospitals, clinics, and health care systems use tall man lettering in their computerized order entry, automated dispensing machines, medication admission records, prescription labels, and drug product labels.<ref>Examples: [http://uuhsc.utah.edu/pharmacy/alerts/191.html "University of Utah Health Care Pharmacy Alert #191"] dated 2006/12/04, browsed 2007/12/20; [http://www.fraserhealth.ca/NR/rdonlyres/ewn3tcyxapmdwy2tuswtkze6o4gueut4oe2gwl752igxymg4agig4eofkj2vazzf6bg44rn5c7lkdj/DocKnowSept06.pdf Fraser Health 'Doctors in the Know' newsletter] dated September, 2006, browsed 2007/12/20; [https://web.archive.org/web/20070315205409/http://www.hopkinsmedicine.org/anesthesiology/Headlines/news_0725_Hosp_Pharm_July2005.pdf Johns Hopkins Hospital "Pharmacy and Therapeutics Newsletter"] dated July 2005, archived 2007/3/15.</ref>

==Effectiveness== Wrong-drug errors have been found to occur at a rate of about one per thousand orders filled or dispensed.<ref name=Lambert /> Evidence regarding the effect of Tall Man lettering on error rates is mixed.

A 2004 [[eye-tracking]] study found that Tall Man lettering resulted in fewer errors when selecting a target drug from an array of choices.<ref>{{cite journal |last1=Filik |first1=R |last2=Purdy |first2=K |last3=Gale |first3=A |last4=Gerrett |first4=D |date=December 2004 |title=Drug name confusion: Evaluating the effectiveness of capital ("Tall Man") letters using eye movement data |journal=[[Social Science & Medicine]] |volume=59 |issue=12 |pages=2597–601 |doi=10.1016/j.socscimed.2004.04.008 |pmid=15474212 }}</ref> Other laboratory-based studies of Tall Man lettering show a mixture of positive and [[null result]]s, which may be further complicated due to [[demand characteristics]] of some of the studies.<ref name=Lambert />

A 2016 [[time-series analysis]] of data from 42 children's hospitals over a 9-year period found no significant difference before and after a 2007 recommendation for hospitals to adopt Tall Man lettering.<ref>{{cite journal |first1=Wenjun |last1=Zhong |first2=James A |last2=Feinstein |first3=Neil S |last3=Patel |first4=Dingwei |last4=Dai |first5=Chris |last5=Feudtner |title=Tall Man lettering and potential prescription errors: A time series analysis of 42 children's hospitals in the USA over 9 years |journal=[[BMJ Quality & Safety]] |year=2016 |volume=25 |issue=4 |pages=233–240 |doi=10.1136/bmjqs-2015-004562 |doi-access=free |pmid=26534995 }}</ref> However, this study has been criticized due to methodological limitations, such as not recording when and how Tall Man lettering was adopted, if at all, at each of the hospitals studied.<ref name=Lambert>{{cite journal |title=Does Tall Man lettering prevent drug name confusion errors? Incomplete and conflicting evidence suggest need for definitive study |first1=Bruce L |last1=Lambert |first2=Scott R |last2=Schroeder |first3=William L |last3=Galanter |department=Editorial |journal=[[BMJ Quality & Safety]] |year=2016 |volume=25 |issue=4 |pages=213–217 |doi=10.1136/bmjqs-2015-004929 |pmid=26700541 |doi-access=free }}</ref>

==Examples== The FDA published a list<ref name=ismp>{{cite web|title= Look-Alike Drug Names with Recommended Tall Man Letters |url= https://www.ismp.org/recommendations/tall-man-letters-list| website= ISMP.org| date= November 20, 2016| publisher= Institute for Safe Medication Practices| accessdate=2022-01-10}} [https://www.adldata.org/wp-content/uploads/2015/06/tallmanletters.pdf PDF attachment (registration needed, 2011 version)]</ref>{{rp|at=Table 1}} of recommended Tall-Man Letters for look-alike drugs which includes, but is not limited to: *[[acetazolamide|acetaZOLAMIDE]] vs. [[acetohexamide|acetoHEXAMIDE]] *[[bupropion|buPROPion]] vs. [[buspirone|busPIRone]] *[[chlorpromazine|chlorproMAZINE]] vs. [[chlorpropamide|chlorproPAMIDE]] *[[clomiphene|clomiPHENE]] vs. [[clomipramine|clomiPRAMINE]] *[[cycloserine|cycloSERINE]] vs. [[cyclosporine|cycloSPORINE]] *[[daunorubicin|DAUNOrubicin]] vs. [[doxorubicin|DOXOrubicin]] *[[dobutamine|DOBUTamine]] vs. [[dopamine|DOPamine]] *[[hydralazine|hydrALAzine]] vs. [[hydroxyzine|hydrOXYzine]] *[[tolazamide|TOLAZamide]] vs. [[tolbutamide|TOLBUTamide]] *[[vinblastine|vinBLAStine]] vs. [[vincristine|vinCRIStine]]

The [[Institute for Safe Medication Practices]] (ISMP) has a supplemental list covering pairs not recommended by the FDA, but considered necessary by the ISMP.<ref name=ismp/>{{rp|at=Table 2}} ISMP Canada also offers additional recommendations.<ref>{{cite web |title=TALLman Lettering for Look-Alike/Sound-Alike Drug Names in Canada |url=https://www.ismp-canada.org/download/TALLman/TALLman_lettering.pdf |website=ismp-canada.org |access-date=25 October 2022}}</ref>

==See also== *[[Health informatics]]

== References == {{reflist}}

==External links== *[http://www.ismp.org/Newsletters/acutecare/articles/20101118.asp ISMP updates its list of drug name pairs with TALL man letters], November 18, 2010 * {{cite web |title=Drug Labelling and the Application of TALLman Lettering Project Report |url=https://www.ismp-canada.org/download/TALLman/TALLmanLettering-ProjectReport.pdf |website=Institute for Safe Medication Practices Canada |date=March 2016}} &ndash; for an overview, and for a list of TALLman respelling systems [[Category:Health informatics]] [[Category:Pharmacy]] [[Category:Capitalization]]