Improving Patient Safety - IELTS Reading Answers & Explanations
From IELTS Recent Actual Test 5 Academic Reading Test 1 · Part 3 · Questions 27–40
Reading Passage
You should spend about 20 minutes on Questions 27-40, which are based on Reading Passage 3 below.
Improving Patient Safety
Packaging
One of the most prominent design issues in pharmacy is that of drug packaging and patient information leaflets (PILs). Many letters have appeared in The Journal's letters pages over the years from pharmacists dismayed at the designs of packaging that are "accidents waiting to happen".
Packaging design in the pharmaceutical industry is handled by either in-house teams or design agencies. Designs for over-the-counter medicines, where characteristics such as attractiveness and distinguishability are regarded as significant, are usually commissioned from design agencies. A marketing team will prepare a brief and the designers will come up with perhaps six or seven designs. These are whittled down to two or three that might be tested on a consumer group. In contrast, most designs for prescription-only products are created in-house. In some cases, this may simply involve applying a company's house design (ie, logo, colour, font, etc). The chosen design is then handed over to design engineers who work out how the packaging will be produced.
Design considerations
The author of the recently published "Information design for patient safety," Thea Swayne, tracked the journey of a medicine from manufacturing plant, through distribution warehouses, pharmacies and hospital wards, to patients' homes. Her book highlights a multitude of design problems with current packaging, such as look-alikes and sound-alikes, small type sizes and glare on blister foils. Situations in which medicines are used include a parent giving a cough medicine to a child in the middle of the night and a busy pharmacist selecting one box from hundreds. It is argued that packaging should be designed for moments such as these. "Manufacturers are not aware of the complex situations into which products go. As designers, we are interested in not what is supposed to happen in [hospital] wards, but what happens in the real world," Ms Swayne said.
Incidents where vein has been injected intrathecally instead of spine are a classic example of how poor design can contribute to harm. Investigations following these tragedies have attributed some blame to poor typescript.
Safety and compliance
Child protection is another area that gives designers opportunities to improve safety. According to the Child Accident Prevention Trust, seven out of 10 children admitted to hospital with suspected poisoning have swallowed medicines. Although child-resistant closures have reduced the number of incidents, they are not fully child-proof. The definition of such a closure is one that not more than 15 percent of children aged between 42 and 51 months can open within five minutes. There is scope for improving what is currently available, according to Richard Mawle, a freelance product designer. "Many child-resistant packs are based on strength. They do not necessarily prevent a child from access, but may prevent people with a disability," he told The Journal. "The legal requirements are there for a good reason, but they are not good enough in terms of the users," he said. "Older people, especially those with arthritis, may have the same level of strength as a child," he explained, and suggested that better designs could rely on cognitive skills (eg, making the opening of a container a three-step process) or be based on the physical size of hands.
Mr. Mawle worked with GlaxoSmithKline on a project to improve compliance through design, which involved applying his skills to packaging and PILs. Commenting on the information presented, he said: "There can be an awful lot of junk at the beginning of PILs. For example, why are company details listed towards the beginning of a leaflet when what might be more important for the patient is that the medicine should not be taken with alcohol?"
Design principles and guidelines
Look-alike boxes present a potential for picking errors and an obvious solution would be to use colours to highlight different strengths. However, according to Ms.Swayne, colour differentiation needs to be approached with care. Not only should strong colour contrasts be used, but designating a colour to a particular strength (colour coding) is not recommended because this could lead to the user not reading the text on a box.
Design features can provide the basis for lengthy debates. For example, one argument is that if all packaging is white with black lettering, people would have no choice but to read every box carefully. The problem is that trials of drug packaging design are few—common studies of legibility and comprehensibility concern road traffic signs and visual display units. Although some designers take results from such studies into account, proving that a particular feature is beneficial can be difficult. For example, EU legislation requires that packaging must now include the name of the medicine in Braille but, according to Karel van der Waarde, a design consultant to the pharmaceutical industry, "it is not known how much visually impaired patients will benefit nor how much the reading of visually able patients will be impaired".
More evidence might, however, soon be available. EU legislation requires PILs to reflect consultations with target patient groups to ensure they are legible, clear and easy to use. This implies that industry will have to start conducting tests. Dr. van der Waarde has performed readability studies on boxes and PILS for industry. A typical study involves showing a leaflet or package to a small group and asking them questions to test understanding. Results and comments are used to modify the material, which is then tested on a larger group. A third group is used to show that any further changes made are an improvement. Dr. van der Waarde is, however, sceptical about the legal requirements and says that many regulatory authorities do not have the resources to handle packaging information properly. "They do not look at the use of packaging in a practical context—they only see one box at a time and not several together as pharmacists would do," he said.
Innovations
The RCA innovation exhibition this year revealed designs for a number of innovative objects. "The popper", by Hugo Glover, aims to help arthritis sufferers remove tablets from blister packs, and "pluspoint", by James Cobb, is an adrenaline auto-injector that aims to overcome the fact that many patients do not carry their auto-injectors due to their prohibitive size. The aim of good design, according Roger Coleman, professor of inclusive design at the RCA, is to try to make things more user-friendly as well as safer. Surely, in a patient-centred health system, that can only be a good thing. "Information design for patient safety" is not intended to be mandatory. Rather, its purpose is to create a basic design standard and to stimulate innovation. The challenge for the pharmaceutical industry, as a whole, is to adopt such a standard.
Questions
Questions 27–32 Matching Features
Look at the following statements and the list of people or organisation below.
Match each statement with the correct person or organisation, A-D.
Write the correct letter, A-D.
NB You may use any letter more than once.
A. Thea Swayne
B. Children Accident Prevention Trust
C. Richard Mawle
D. Karel van der Waarde
Questions 33–37 Note Completion
Complete the notes using the list of words, A-G, below.
Write the correct letter, A-G.
A consumers B marketing teams C pharmaceutical industry
D external designers E in-house designers F design engineers
G pharmacist
Packaging in pharmaceutical industry
Designs for over-the-counter medicines
First, 33 make the proposal, then pass them to the 34. Finally, these designs will be tested by 35.
Prescription-only
First, the design is made by 36 and then subjected to 37.
Questions 38–40 Multiple Choice (One Answer)
Choose the correct letter, A, B, C or D.
Write the correct letter.
Answers & Explanations Summary
| # | Answer | Evidence | Explanation |
|---|---|---|---|
| Q27 | C | "Older people, especially those with arthritis, may have the same level of strength as a child," he explained, and suggested that better designs could rely on cognitive skills (eg, making the opening of a container a three-step process) or be based on the physical size of hands | Excerpt/Passage Explanation: The passage says that Richard Mawle thinks old people, especially if they have arthritis (a joint problem), might be as weak as a child. Because of this, he suggests that medicine containers should be designed to be opened using thinking skills or by the size of a person's hands, instead of just needing a lot of strength. Answer Explanation: The answer is Richard Mawle. He is a person who designs things and works on making medicine packaging better. Reason For Correctness: The correct answer is Richard Mawle because he states that older people, especially those with arthritis, can have the same difficulty opening strong child-resistant containers as children do. He points out that if a design relies only on how much strength someone has, it might stop people with disabilities or older people from getting to their medicine, even if it's meant to stop children. |
| Q28 | D | EU legislation requires that packaging must now include the name of the medicine in Braille but, according to Karel van der Waarde, a design consultant to the pharmaceutical industry, "it is not known how much visually impaired patients will benefit nor how much the reading of visually able patients will be impaired" | Excerpt/Passage Explanation: The passage says that rules now make companies put the medicine's name in Braille (a special writing for blind people) on the box. But Karel van der Waarde, an expert in design for medicine companies, said we don't know if this change will truly help blind people a lot, or if it will make it harder for people who can see to read the boxes. Answer Explanation: The answer is D. This means Karel van der Waarde said that changing medicine boxes for people who cannot see well might make it harder for people who can see well to read them. Reason For Correctness: The correct answer is Karel van der Waarde because the passage directly quotes him talking about how adding Braille (raised dots for blind people) to medicine packaging might affect people who can see. He mentions that it is not clear how much "visually able patients" (people who can see) might have their reading made "impaired" (harder or worse) by these changes. This matches the idea that adapting packaging for the blind might disadvantage the sighted. |
| Q29 | B | According to the Child Accident Prevention Trust, seven out of 10 children admitted to hospital with suspected poisoning have swallowed medicines. Although child-resistant closures have reduced the number of incidents, they are not fully child-proof | Excerpt/Passage Explanation: The passage says that the Child Accident Prevention Trust reports that many children go to the hospital because they accidentally swallowed medicine. It also says that special bottle tops designed to stop children are helpful and make fewer accidents happen, but they do not work perfectly every time to keep children completely safe from the medicine. Answer Explanation: The answer B means that the organization called the 'Child Accident Prevention Trust' states that special safety tops for medicine bottles do not completely stop children from taking pills by mistake. Reason For Correctness: The correct answer is B because the passage clearly states that the 'Child Accident Prevention Trust' provided information about child protection and medicine safety. It mentions that even though 'child-resistant closures' (which are like specially designed lids) have helped, they are 'not fully child-proof', meaning children can still sometimes open them or swallow medicine by accident. This directly matches the idea in the question. |
| Q30 | A | Situations in which medicines are used include a parent giving a cough medicine to a child in the middle of the night and a busy pharmacist selecting one box from hundreds. It is argued that packaging should be designed for moments such as these. "Manufacturers are not aware of the complex situations into which products go. As designers, we are interested in not what is supposed to happen in [hospital] wards, but what happens in the real world," Ms Swayne said | Excerpt/Passage Explanation: The passage talks about different times when people use medicine, like a mom or dad giving cough medicine to a child late at night, which happens at home. It says that medicine packaging should be made for these kinds of moments. Ms. Swayne adds that companies don't always know about these real-life situations, but designers care about how things are used in the 'real world,' not just in hospitals. Answer Explanation: The answer is A, which means Thea Swayne. She believes that medicine containers should be made with real-life situations in mind, including how people use medicines at home. Reason For Correctness: The correct answer is Thea Swayne because the passage clearly states that she believes packaging should be designed for 'real-world' situations, including drug use at home. The text gives a specific example of a parent giving medicine to a child at night, which is a home situation. The passage directly connects this idea to Ms. Swayne's views, saying 'It is argued that packaging should be designed for moments such as these' and then immediately follows with her quote about designers being interested in 'what happens in the real world'. |
| Q31 | D | Dr. van der Waarde is, however, sceptical about the legal requirements and says that many regulatory authorities do not have the resources to handle packaging information properly. "They do not look at the use of packaging in a practical context—they only see one box at a time and not several together as pharmacists would do," he said | Excerpt/Passage Explanation: The passage states that Dr. van der Waarde thinks the groups that set rules do not have enough help to check medicine packaging well. He said these groups only look at one package at a time, not many packages together, which is how people like pharmacists use them. Looking at many together would help them understand real-world use better. Answer Explanation: The answer is D. This means the person named Karel van der Waarde believes that official groups controlling rules should look at many different medicine packages together, not just one at a time. Reason For Correctness: The correct answer is D because Karel van der Waarde, a design consultant, expressed concern that regulatory authorities (governing bodies) do not look at how medicine packaging is used in real life. He explained they only examine 'one box at a time' instead of seeing 'several together,' which would be more helpful for understanding how people, like pharmacists, actually handle them. This matches the idea that governing bodies should investigate many different container cases rather than individual ones to get a complete picture. |
| Q32 | C | Commenting on the information presented, he said: "There can be an awful lot of junk at the beginning of PILs. For example, why are company details listed towards the beginning of a leaflet when what might be more important for the patient is that the medicine should not be taken with alcohol?" | Excerpt/Passage Explanation: The passage shows that Richard Mawle thinks there is too much unimportant information at the start of the patient leaflets. He gives an example of company details being listed first, even though information about not mixing medicine with alcohol is more important for patients and should probably be earlier. Answer Explanation: The answer is Richard Mawle. He said that information in the patient leaflets is not always in the best order. Reason For Correctness: The correct answer is Richard Mawle because he specifically mentioned that the information in patient information leaflets (PILs) is not arranged in the correct or most helpful order. He pointed out that less important 'company details' are often placed at the beginning, while more important 'information' for the patient, like not taking the medicine with alcohol, comes later. This matches the idea that information hasn't been in the right order. |
| Q33 | B | A marketing team will prepare a brief and the designers will come up with perhaps six or seven designs | Excerpt/Passage Explanation: The passage says that a 'marketing team' will write a plan or idea (a 'brief'). After this, the designers will create several different designs based on that plan. Answer Explanation: The answer is 'B', which means 'marketing teams'. This group starts the design process for over-the-counter medicines. Reason For Correctness: The correct answer is 'B' because the passage specifically states that 'marketing teams' are responsible for preparing the initial proposal or 'brief' for the designs of over-the-counter medicines. This happens before any designs are created. |
| Q34 | D | Designs for over-the-counter medicines, where characteristics such as attractiveness and distinguishability are regarded as significant, are usually commissioned from design agencies. A marketing team will prepare a brief and the designers will come up with perhaps six or seven designs | Excerpt/Passage Explanation: The passage says that for medicines you can buy without a doctor's order (over-the-counter), companies usually ask 'design agencies' to create the packaging. A 'marketing team' tells them what they want, and then these 'designers' (from the agencies) create many ideas for the packaging. Answer Explanation: The answer is D, which means 'external designers'. These are people or companies outside the main company who are hired to create designs. Reason For Correctness: The correct answer is 'external designers' because the passage states that for 'over-the-counter medicines', designs are usually ordered from 'design agencies'. These design agencies are companies or groups of people who are not directly part of the medicine company, meaning they are 'external' or outside designers. They are the ones who 'come up with' or propose the initial designs after getting instructions from a marketing team. |
| Q35 | A | These are whittled down to two or three that might be tested on a consumer group | Excerpt/Passage Explanation: The passage says that after some designs for medicine packaging are created, only a few are chosen and then shown to 'a consumer group'. This means a group of regular people who might buy the medicine will look at them and give their opinions. Answer Explanation: The answer is A, which means 'consumers'. This word refers to the people who buy and use things, like medicines. Reason For Correctness: The correct answer is 'consumers' because the passage explains that for over-the-counter medicines, after several designs are made, they are 'tested on a consumer group'. This means that people who might buy the medicine are asked to try the designs to see what they think. |
| Q36 | E | In contrast, most designs for prescription-only products are created in-house | Excerpt/Passage Explanation: The passage states that for medicines that need a doctor's note (prescription-only), most of the design work is done by people working within the company itself, not by outside design companies. Answer Explanation: The answer, 'E', means that the first designs for medicines that need a doctor's permission are made by people who work inside the same company that makes the medicine. Reason For Correctness: The correct answer is 'E' because the passage states that most designs for medicines that can only be bought with a 'prescription' are created 'in-house', meaning by the company itself. Therefore, 'in-house designers' are the ones who make these initial designs. |
| Q37 | F | The chosen design is then handed over to design engineers who work out how the packaging will be produced | Excerpt/Passage Explanation: The passage says that once a design for packaging is picked, it is given to 'design engineers'. Their job is to find out the best way to make that packaging. Answer Explanation: The answer 'F' means 'design engineers'. These are people who plan how a product will be made. Reason For Correctness: The correct answer is 'F' because the passage explains how packaging for 'prescription-only products' is made. It says that after a design is chosen, it is then given to 'design engineers' who figure out how to produce the packaging. So, the design is 'subjected to' or passed on to the design engineers. |
| Q38 | B | Incidents where vein has been injected intrathecally instead of spine are a classic example of how poor design can contribute to harm. Investigations following these tragedies have attributed some blame to poor typescript | Excerpt/Passage Explanation: The passage explains that bad design can cause harm, and it gives an example: mistakes happened because the 'typescript' was poor. 'Typescript' means how the text or words looked on the packaging. So, if the writing style was bad, it caused problems. Answer Explanation: The answer B means that a problem with how the words are written or shown on the medicine packaging can cause mistakes or accidents. Reason For Correctness: The correct answer is B because the passage clearly states that 'poor design' can cause harm, and in one specific example of a serious accident, the investigations found that 'poor typescript' was partly to blame. 'Typescript' refers to the style or quality of the printed words, which directly relates to 'style of print'. This means that if the words on the packaging are hard to read or look confusing, it can lead to mistakes. |
| Q39 | B | For example, one argument is that if all packaging is white with black lettering, people would have no choice but to read every box carefully | Excerpt/Passage Explanation: The passage talks about an idea: if all medicine packages are plain white with only black writing, then people would not have other clues (like color) and would *have* to carefully read what is written on every box. Answer Explanation: The answer means that if all medicine boxes were just white with black words, people would need to read everything on the box very carefully. Reason For Correctness: The correct answer is B because the passage explains an idea that if all medicine packaging had only white boxes with black words, people would be forced to read each box with great attention. This 'careful' reading directly means they would 'pay more attention to the information,' which is what option B states. The passage presents this as an argument aimed at preventing mistakes. |
| Q40 | A | The RCA innovation exhibition this year revealed designs for a number of innovative objects. "The popper", by Hugo Glover, aims to help arthritis sufferers remove tablets from blister packs, and "pluspoint", by James Cobb, is an adrenaline auto-injector that aims to overcome the fact that many patients do not carry their auto-injectors due to their prohibitive size | Excerpt/Passage Explanation: The passage says that a show displayed new and clever designs. Two examples, 'The popper' and 'pluspoint', were shown. 'The popper' helps people with joint pain take pills from packages, and 'pluspoint' is a smaller medicine injector, which helps people carry it more easily because the old ones were too big. Answer Explanation: The answer means that the writer talks about 'popper' and 'pluspoint' to show that there have been good changes and improvements in how medicine containers are designed. Reason For Correctness: The correct answer is A because the passage introduces 'popper' and 'pluspoint' in the section called 'Innovations'. These are described as 'innovative objects' that 'aims to help' people with arthritis and 'aims to overcome' the issue of large auto-injectors. These examples demonstrate positive developments and advancements in design, indicating that progress has been made. |