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Reducing Medication Errors

Promoting the adoption and use of patient-centered prescription labels across health systems in Wisconsin

Full Project Name:Reducing Medication Errors: Adopting Evidence-Based Directions for Use on Prescription LabelsPrimary Community Organization:Wisconsin Literacy, Inc.Primary Academic Partner:Ken Schellhase, MD, MPHPrincipal Investigator:Ken Schellhase, MD, MPHAward Amount:468413
Award Date
July2021
Project Duration:36

Project Description Narrative:


Studies show that more than 1/3 of U.S adults have only a basic level of health literacy. Due to this, 50% of medications are taken incorrectly, causing unnecessary post-discharge complications, hospitalizations, and even death. Over the past seven years, Wisconsin Health Literacy and partners have been successfully working with pharmacies to redesign prescription labels using evidence-based standards. The result has been increased patient understanding, improved adherence to medications, and reduced health disparities. However, due to software and other limitations, a vital gap remains in improving the directions for use on prescriptions.

Through this award, project partners aim to bridge this gap by working with Wisconsin health systems to adopt changes in the electronic health record software that will make the use of evidence-based prescription labels and directions for use the default choice for prescribers.

Community partners: Epic Systems, Wisconsin Medical Society, Wisconsin Hospital Association, Pharmacy Society of Wisconsin, Advocate Aurora Health Care, UW Health, UW-Madison School of Pharmacy, Emory University

Outcomes & Lessons Learned:


  • Conducted outreach and advocacy to 18 of the 21 organizations that use Epic in Wisconsin to explore the adoption of Epic’s UMS feature for patient-centered prescription labels resulting in Advocate Aurora adopting use of the feature and 3.5-4 million prescriptions per month prescribed using UMS directions nationwide
  • Engaged a Wisconsin free clinic to implement clear and explicit directions and other health literacy best practices into their pharmacy processes leading to exploration of implementation with additional Wisconsin-based free clinics
  • Presented about the project during the 2022 and 2023 CMO/Physician Leadership Summit reaching attendees from 11 Wisconsin health systems, United Healthcare, and the American Medical Association
  • Analyzing Medicare Part D data from the Centers of Medicare and Medicaid Services to determine the impact of patient-centered medication labels and disseminate results to support additional buy-in

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