Tall man lettering as a solution for look-alike sound-alike errors: A systematic literature review

• Tall Man Lettering (TML) is a visual strategy recommended by the FDA to reduce Look-Alike Sound-Alike (LASA) medication errors. • A review of 25 experiments found mixed evidence for TML’s effectiveness—some improvements in accuracy, but many studies showed no benefit or even negative effects. • TML effectiveness varies based on user background, drug familiarity, orthographic similarity, position of TML, and exposure time. • TML works best in specific conditions but is not effective as a standalone solution. Medication errors, particularly those involving Look-Alike Sound-Alike (LASA) drugs, are a critical concern in healthcare, often resulting in adverse patient outcomes. Tall Man Lettering (TML) has been proposed as a visual enhancement strategy to mitigate these errors by making drug names more distinguishable. This systematic literature review evaluates the effectiveness of TML in reducing LASA errors and identifies factors contributing to the variability in its effectiveness across different healthcare settings and populations. The review encompasses data from 16 studies, incorporating 25 experiments. The findings reveal mixed results regarding the efficacy of TML, with some studies demonstrating significant improvements, whereas others report no effect or even negative outcomes. Key factors influencing the effectiveness of TML include participant group (healthcare professionals vs. non-professionals), drug familiarity, awareness of TML's purpose, target presence, exposure time, and orthographic similarity. These results suggest that while TML can be beneficial in specific contexts, its universal application as a standalone solution is limited. The review highlights the need for integrating multiple strategies to enhance medication safety and calls for further research to improve the generalizability and real-world applicability of TML interventions.