AAEECE Worlwide Patient Safety Initiative Proposed Solutions Rating Worksheet for PATIENTS

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1. HOW MANY DIFFERENT EYE OR EAR MEDICATIONS HAVE YOU USED OVER THE LAST YEAR FOR YOUR MEDICAL CONDITION(S)?

HOW MANY DIFFERENT EYE OR EAR MEDICATIONS HAVE YOU USED OVER THE LAST YEAR FOR YOUR MEDICAL CONDITION(S)?   1-2

2-3

4-5

6 or More

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2. PRINT THE DRUG NAME ON THE TWIST OFF CAP OF EACH PRODUCT.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*PRINT THE DRUG NAME ON THE TWIST OFF CAP OF EACH PRODUCT. SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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3. PRINT THE DRUG'S NAME ON A PROTECTIVE PLASTIC SEAL THAT WRAPS AROUND THE CAP AND MUST BE BROKEN TO USE THE DRUG.

NOTE:This additional safety system would only help patients until the plastic seal is removed and discarded upon first use.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*PRINT THE DRUG'S NAME ON A PROTECTIVE PLASTIC SEAL THAT WRAPS AROUND THE CAP AND MUST BE BROKEN TO USE THE DRUG. NOTE:This additional safety system would only help patients until the plastic seal is removed and discarded upon first use. SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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4. USE VARIOUS LETTERING STYLES AND SIZES TO MAKE THE DRUG NAMES LOOK DIFFERENT ON PRODUCTS.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*USE VARIOUS LETTERING STYLES AND SIZES TO MAKE THE DRUG NAMES LOOK DIFFERENT ON PRODUCTS. SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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5. CONSIDER THE ADDITION OF TALL MAN LETTERING SYSTEMS ON LABELS. SEE EXAMPLES BELOW:

EXAMPLES: TobrADEX and TobrEX * AZopt and COSopt * XALatan and TRAVatan

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*CONSIDER THE ADDITION OF TALL MAN LETTERING SYSTEMS ON LABELS. SEE EXAMPLES BELOW: EXAMPLES: TobrADEX and TobrEX * AZopt and COSopt * XALatan and TRAVatan SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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6. USE NEW WAYS OF COLOR-CODING LABELS ON DIFFERENT LOCATIONS OF THE PRODUCTS.

EXAMPLE: Color-code the tips of twist off caps and/or the neck of bottles.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*USE NEW WAYS OF COLOR-CODING LABELS ON DIFFERENT LOCATIONS OF THE PRODUCTS. EXAMPLE: Color-code the tips of twist off caps and/or the neck of bottles. SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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7. BOLD/DARKEN AND EXAGGERATE THE SIZE OF DRUG'S STRENGTH ON THE PRODUCT LABEL.

EXAMPLE: Pilocarpine 1%

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*BOLD/DARKEN AND EXAGGERATE THE SIZE OF DRUG'S STRENGTH ON THE PRODUCT LABEL. EXAMPLE: Pilocarpine 1% SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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8. BOLD/DARKEN AND EXAGGERATE THE DRUG'S STRENGTH SIZE DIRECTLY ON THE BOTTLE'S TWIST-OFF CAP.

EXAMPLE: Pilocarpine 2%

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY:	*BOLD/DARKEN AND EXAGGERATE THE DRUG'S STRENGTH SIZE DIRECTLY ON THE BOTTLE'S TWIST-OFF CAP. EXAMPLE: Pilocarpine 2% SELECT ONE ONLY: EXCELLENT-5	SELECT ONE ONLY: VERY GOOD-4	SELECT ONE ONLY: GOOD-3	SELECT ONE ONLY: FAIR-2	SELECT ONE ONLY: POOR-1

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9. MAKE IT MANDATORY FOR ONE SIDE OF ALL 6 SIDED BOXES (PREFERABLY ONE OF THE SIDE PANELS)TO INCLUDE :THE BRAND AND GENERIC NAME, COMPANY NAME, AND PACKAGE SIZE PRINTED HORIZONTALLY AND IN LARGE, BOLD/DARK PRINT).

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY	*MAKE IT MANDATORY FOR ONE SIDE OF ALL 6 SIDED BOXES (PREFERABLY ONE OF THE SIDE PANELS)TO INCLUDE :THE BRAND AND GENERIC NAME, COMPANY NAME, AND PACKAGE SIZE PRINTED HORIZONTALLY AND IN LARGE, BOLD/DARK PRINT). SELECT ONE ONLY EXCELLENT-5	SELECT ONE ONLY VERY GOOD-4	SELECT ONE ONLY GOOD-3	SELECT ONE ONLY FAIR-2	SELECT ONE ONLY POOR-1

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10. CHANGE THE EXISTING COLOR CODING SYSTEM THAT REQUIRES ALL EYE DROPS IN THE SAME FAMILY TO HAVE THE SAME COLOR TWIST-OFF CAPS AND MOVE THE COLOR TO THE BOTTOM OF THE OPHTHALMIC BOTTLE.ALL BOTTLE CAPS WOULD BECOME WHITE CAUSING PATIENTS AND HEALTHCARE PROFESSIONALS TO READ THE LABEL TO PICK THE DRUG RATHER PICKING THE DRUG BASED ON THE CAPS COLOR.

EXAMPLES: PILOCARPINE 0.5%, 2% and 4% ALL HAVE GREEN CAPS

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONE ONLY	*CHANGE THE EXISTING COLOR CODING SYSTEM THAT REQUIRES ALL EYE DROPS IN THE SAME FAMILY TO HAVE THE SAME COLOR TWIST-OFF CAPS AND MOVE THE COLOR TO THE BOTTOM OF THE OPHTHALMIC BOTTLE.ALL BOTTLE CAPS WOULD BECOME WHITE CAUSING PATIENTS AND HEALTHCARE PROFESSIONALS TO READ THE LABEL TO PICK THE DRUG RATHER PICKING THE DRUG BASED ON THE CAPS COLOR. EXAMPLES: PILOCARPINE 0.5%, 2% and 4% ALL HAVE GREEN CAPS SELECT ONE ONLY EXCELLENT-5	SELECT ONE ONLY VERY GOOD-4	SELECT ONE ONLY GOOD-3	SELECT ONE ONLY FAIR-2	SELECT ONE ONLY POOR-1

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11. MAKE ALL OPHTHALMIC BOTTLES ONE SHAPE AND ALL OTIC BOTTLES ANOTHER/DIFFERENT SHAPE.

*This will be especially helpful for sight impaired patients.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*MAKE ALL OPHTHALMIC BOTTLES ONE SHAPE AND ALL OTIC BOTTLES ANOTHER/DIFFERENT SHAPE. *This will be especially helpful for sight impaired patients. SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1

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12. MAKE ALL OPHTHALMIC AND OTIC BOTTLE SIZES BIGGER IN SIZE SO LARGER LABELS WITH BIGGER LETTERS CAN BE USED.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*MAKE ALL OPHTHALMIC AND OTIC BOTTLE SIZES BIGGER IN SIZE SO LARGER LABELS WITH BIGGER LETTERS CAN BE USED. SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1

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13. ASSIGN SPECIFIC COLORS TO LABELS, BOXES, AND/OR CONTAINERS SO THAT NO TWO PRODUCTS HAVE THE EXACT SAME COLOR SCHEME.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*ASSIGN SPECIFIC COLORS TO LABELS, BOXES, AND/OR CONTAINERS SO THAT NO TWO PRODUCTS HAVE THE EXACT SAME COLOR SCHEME. SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1

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14. CREATE UNIQUE AND INDIVIDUAL SHAPES FOR EYE/OPHTHALMIC PRODUCTS.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*CREATE UNIQUE AND INDIVIDUAL SHAPES FOR EYE/OPHTHALMIC PRODUCTS. SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1

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15. STUDY WHICH COLORS ARE EASIEST FOR PATIENTS TO READ ON DRUG LABELS AND ONLY USE THOSE COLORS.

*Helpful for color-blind and other patients who cannot differentiate colors

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*STUDY WHICH COLORS ARE EASIEST FOR PATIENTS TO READ ON DRUG LABELS AND ONLY USE THOSE COLORS. *Helpful for color-blind and other patients who cannot differentiate colors SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1

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16. ADD RAISED SYMBOLS OR BRAILLE (LETTERING FOR THE BLIND)ONTO BOTTLES AND BOXES FOR PEOPLE WHO HAVE DIFFICULTY OR CANNOT SEE AT ALL CAN IDENTIFY THEIR EYE MEDS.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*ADD RAISED SYMBOLS OR BRAILLE (LETTERING FOR THE BLIND)ONTO BOTTLES AND BOXES FOR PEOPLE WHO HAVE DIFFICULTY OR CANNOT SEE AT ALL CAN IDENTIFY THEIR EYE MEDS. SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1

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17. ADD A RED BOX AROUND THE DRUG'S EXPIRATION DATE SO PEOPLE CAN FIND AND READ THEM MORE EASILY.

	EXCELLENT-5	VERY GOOD-4	GOOD-3	FAIR-2	POOR-1
SELECT ONLY ONE:	*ADD A RED BOX AROUND THE DRUG'S EXPIRATION DATE SO PEOPLE CAN FIND AND READ THEM MORE EASILY. SELECT ONLY ONE: EXCELLENT-5	SELECT ONLY ONE: VERY GOOD-4	SELECT ONLY ONE: GOOD-3	SELECT ONLY ONE: FAIR-2	SELECT ONLY ONE: POOR-1