Implementation fidelity of patient-centered prescription label to promote opioid safe use

Danielle M. McCarthy*, Andrea M. Russell, Morgan R. Eifler, Lauren A. Opsasnick, Abigail E. Lyden, Stephanie J. Gravenor, Enid Montague, Scott I. Hur, Kenzie A. Cameron, Laura M. Curtis, Michael S. Wolf

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Purpose: Patient-centered labels may improve safe medication use, but implementation challenges limit use. We assessed implementation of a patient-centered “PRN” (as needed) label entitled “Take-Wait-Stop” (TWS) with three deconstructed steps replacing traditional wording. Methods: As part of a larger investigation, patients received TWS prescriptions (eg, Take: 1 pill if you have pain; Wait: at least 4 h before taking again; Stop: do not take more than 6 pills in 24 h). Prescriptions labels recorded at follow-up were classified into three categories: (1) one-step wording (Take 1 pill every 4 h [without daily limits]), (2) two-step wording (Take 1 pill every 4 h; do not exceed 6 pills/day), and (3) three-step wording. There were three subtypes of three-step wording: (3a) three-step, not TWS (three deconstructed steps, not necessarily TWS wording), (3b) TWS format, employing three steps with leading verbs, but “with additions or replacements” (eg, replaced “do not take” with “do not exceed”), and (3c) verbatim TWS. Results: Two hundred eleven participants completed follow-up. Mean age was 44.3 years (SD 14.3); 44% were male. One-step bottles represented 12% (n = 25) of the sample, whereas 26% (n = 55) had two-step wording. The majority (44%, n = 93) had three-deconstructed steps, not TWS (3a); 16% (n = 34) retained TWS structure, but not verbatim (3b). Only 2% (n = 4) displayed verbatim TWS wording (3c). All category three labels (utilizing deconstructed instructions) were considered adequate implementation (62%). Conclusions: Exact intervention adherence was not achieved in the majority of cases, limiting impact. Nonetheless, community pharmacies were responsive to new instructions, but higher implementation reliability requires additional supports.

Original languageEnglish (US)
Pages (from-to)1251-1257
Number of pages7
JournalPharmacoepidemiology and Drug Safety
Issue number9
StatePublished - Sep 1 2019


  • acetaminophen-hydrocodone drug combination
  • drug labeling
  • health literacy
  • pharmacies
  • pharmacoepidemiology

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Epidemiology


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