April 9, 2010 / 8:35 PM / 10 years ago

Drug label accuracy getting lost in translation

NEW YORK (Reuters Health) - Computer programs pharmacists rely on to translate prescription labels for non-English speaking customers often produce potentially harmful errors, new research indicates.

A pharmacist looks through shelving to fill a prescription while working at a pharmacy in New York

Examples include translating “once a day” into “eleven times a day”; replacing “by mouth” with “by the little”; and translating “two times” into “two kiss.” While nearly all of the pharmacies surveyed in the study said pharmacists checked label printouts for accuracy, most of these pharmacists weren’t fluent in Spanish.

The consequences of such errors are “immediately apparent and frightening to any physician,” Dr. Iman Sharif and Julia Tse, who conducted the research, note in the journal Pediatrics. There has been at least one documented case of such consequences, they add; a man who was supposed to take his two blood pressure medications once a day took 11 pills of each instead. (The word “once” in English means “eleven” in Spanish.)

“We’re not going to be able to reduce disparities in care if we cannot ensure that patients know how to use their medicines,” Sharif, formerly of Montefiore Medical Center in the Bronx, who is now at the Nemours A.I. DuPont Hospital for Children in Wilmington, Delaware, told Reuters Health in an interview. “Medication errors are a huge problem and this is just one venue where this happens, and I think a really important one.”

In 2009, New York City Mayor Michael Bloomberg signed a law requiring pharmacy chains to offer translated medicine labels to customers speaking one of the seven top foreign languages spoken in the city. Nearly half of New York City’s population speaks a language other than English at home.

To investigate whether Spanish speakers were being provided this service, Sharif and Tse, who is with Dartmouth College in Hanover, New Hampshire, surveyed 286 pharmacies in the Bronx, New York — where 44 percent of the population speaks Spanish — about whether they provided medicine labels in Spanish to their customers who needed them. About three-quarters did so. Among these pharmacies, nearly 90 percent used computers to translate labels from English into Spanish, 11 percent used staff members, and 3 percent used professional interpreters.

Sharif and Tse then looked at 76 medicine labels they had generated using 13 of the 14 computer programs pharmacists reported using for translation.

They found that half of all the labels contained serious mistakes. Thirty-two of the labels included incomplete translations and six contained major spelling or grammatical errors.

Computer translation programs can clearly be improved, Sharif said, but this doesn’t mean a human being shouldn’t be checking the computer’s work. Ideally, she added, pharmacies should have professional translators on staff to ensure that labels are being translated properly. Figuring out how to pay for this, Sharif said, “is probably something that belongs within the health reform conversations.”

Standardizing how doctors write prescriptions and ensuring they use precise language will make accurate translation much easier, the researcher added. She also urges people to repeat back the instructions on medication use that their doctors and pharmacists give them to catch any potentially dangerous miscommunications.

Non-English-speakers should demand help in interpreting their medication labels, according to Sharif. “Ask for a professional interpreter, don’t just accept that you don’t speak English and therefore you don’t get to have information about your medicine.”

SOURCE: Pediatrics, May 2010.

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