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Introduction Patient compliance in the use of eye-drops in conditions such as glaucoma can have a considerable influence on disease progression. A clear explanation of how to instil the drops, together with clearly labelled medication, is vital in aiding patients' understanding of how to use their medication. This audit project sought to examine whether patients attending an outpatient pharmacy were given such an explanation, and the extent to which they were able to read the labelling and subsequently use their treatments. Method A self-completed questionnaire, designed jointly by pharmacy and the audit office, was typed in size 16 font and printed on yellow paper to ensure maximum clarity.1 The questionnaire was then offered to all ophthalmic outpatients attending the pharmacy during one week, Monday to Friday. |
Focal points
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Results In total, 75 questionnaires were given out and 66 were returned (88 per cent response); 58 per cent of respondents were female and 39 per cent male. Over 60 per cent were aged 60 years or above. Over 15 per cent were aged 80 years or above. Eighty-six per cent of patients had completed the questionnaire themselves; 73 per cent of the respondents administering their own eye medication.
Is the current label easy to read? - Forty-two per cent found the label easy to read; 33 per cent did so with glasses, while 14 per cent had some difficulty and the rest needed help.
Does the quality of the label diminish with repeated use? - Seventy-seven per cent thought the label still clear after five days' use, 14 per cent said the label had smudged and a further 5 per cent could not read it. Five per cent did not give an opinion.
Is the eye-drop container easy to use? - Forty-nine per cent thought the bottle easy to use, while 28 per cent found it okay but tricky. Fifteen per cent needed someone to help and 8 per cent admitted to problems.
Problems identified by patients - For knowing if the right number of drops have gone in, 20 per cent had concerns; for knowing if any drops had gone in the eye, 26 per cent had concerns; for holding and squeezing the bottle, 17 per cent had difficulties.
Figure 1. Options favoured by patients |
Discussion The ease of squeezing the bottle to deliver the right dose and the clarity of the written instruction accounted for over 70 per cent of the problems identified.
Thirty per cent of reports for improvement favoured bigger writing, either on the label or on a separate sheet.
Numbers were lower than anticipated due to a cancelled clinic. Despite this, it would still be appropriate to act upon these findings and re-audit once changes were implemented. The study would suggest devices to help with the positioning (Autodrop) or squeezing (Opticare) of standard plastic multidose bottles would be highly beneficial to patients once advised on the correct technique. These devices can be of particular use to patients with associated problems of arthritis or tremor.
The needs of the partially-sighted patients can be met by providing information, in a large font size (14pt or above) with a contrasting background, on a separate instruction sheet.
Any moves to provide clearer labelling which necessitate a larger label or an extended-length label must ensure the changes do not compromise the patient's ability to hold or squeeze the bottle.
Pharmacy action points - Advise putting the eye-drops in a refrigerator prior to use (check stability first); the patient is more likely to feel drops have gone into the eye.2 Offer devices for positioning and squeezing eye-drop containers; demonstrate their use. Publicise a larger print facility on request.
*Health services research co-ordinator and directorate pharmacist (ophthalmology), Royal Hallamshire hospital, Sheffield S10 2JF
| 1. Royal National Institute for the Blind. Clear print guidelines. London: RNIB; 1997. |
| 2. Mansour AM. Tolerance to topical preparations: cold or warm? Ann Ophthalmol 1991;23: 21-2. |