Precautionary allergen labeling: Current communication problems and potential for future improvements

While there are EU laws for priority allergenic ingredients information on food product packaging, there is no legislation about Precautionary Allergen Labelling (PAL) for unintended allergen presence (UAP). As a result, PAL is used in different ways by different manufacturers and retailers, which hampers consumers’ interpretation of the information in the PAL. Previous research has focused on the forms of PAL that are used and on the way they are interpreted and used by consumers. This study adds the perspective of producers, retailers and branch organizations. Thirteen interviews with QA- and QC-professionals were conducted to find out more about the reasoning behind their PAL-use and to find out how PAL could be optimized. Results show that harmonization is needed, on different levels: in the way information on UAP is shared between parties involved in the food chain; in the way PAL is presented and phrased; and in the rules and regulations on PAL. More research is needed on possible ways to share (updates on) information on UAP with consumers

Precautionary allergen labeling: Current communication problems and potential for future improvements

While there are EU laws for priority allergenic ingredients information on food product packaging, there is no legislation about Precautionary Allergen Labelling (PAL) for unintended allergen presence (UAP). As a result, PAL is used in different ways by different manufacturers and retailers, which hampers consumers’ interpretation of the information in the PAL. Previous research has focused on the forms of PAL that are used and on the way they are interpreted and used by consumers. This study adds the perspective of producers, retailers and branch organizations. Thirteen interviews with QA- and QC-professionals were conducted to find out more about the reasoning behind their PAL-use and to find out how PAL could be optimized. Results show that harmonization is needed, on different levels: in the way information on UAP is shared between parties involved in the food chain; in the way PAL is presented and phrased; and in the rules and regulations on PAL. More research is needed on possible ways to share (updates on) information on UAP with consumers

Daily practice performance (Work-as-Done) compared to guidelines (Work-as-Imagined) of medication reconciliation at discharge: Outcomes of a FRAM study

Objectives: Performing medication reconciliation (MR) is an important safety initiative. However, its implementation is complex. We used the Functional Resonance Analysis Method (FRAM) to gain more understanding of healthcare professionals’ low compliance with the standards for MR by comparing Dutch guidelines and hospital protocols (Work-as-Imagined/WAI) with daily clinical practice (Work-as-Done/WAD). Methods: Nine cardiology and orthopaedics wards participated in this study. We applied the FRAM to construct several models to visualise MR at the point of discharge. WAI models were based on national guidelines and hospital protocols. Data to construct the WAD models were collected through semi-structured interviews with the healthcare professionals involved. Results: Sixty-three healthcare professionals were interviewed. These occasionally had to adjust their work in order to manage a lack of time or resources, resulting in variation in healthcare professionals’ performance. This had an impact upon the flow of the reconciliation process due to the interdependency of all the healthcare professionals involved. Conclusion: Collaboration between healthcare professionals is essential to ensure complete reconciliation for discharged patients. We identified a distinction between daily practice and both the guidelines and protocols followed. Future research should indicate the impact of specific variations in practice, and deviations from the protocols on medication safety, during reconciliation

Patient participation during discharge medication counselling: Observing real-life communication between healthcare professionals and patients

Objectives: Previous studies on hospital discharge showed limited patient involvement, despite its positive outcomes. In this study, provider-patient communication used to enhance patient participation during discharge medication counselling was examined. Methods: This study comprises a qualitative descriptive observational study. Thirty-four discharge consultations were observed, audio recorded and analysed. We conducted a deductive analysis, elaborating on findings from earlier research. We selected themes and underlying codes illustrating professional-patient communication. For every theme, we identified examples to demonstrate its manifestation during discharge medication counselling. We also assessed what information healthcare professionals (HCPs) shared. Results: HCPs used cues to increase patient participation, e.g. inquired about patient's preferences, showed empathy and support, and verified understanding of information shared. Patient participation occurred through asking questions, and expressing concerns. A central component in discharge medication counselling was the transmission of information from HCPs to patients. This resulted in HCPs taking a leading role. Conclusions: Several HCP cues were detected inviting patients to participate in consultations. Some patients participated in discharge medication counselling. This was influenced by timing of discharge consults, the performing HCP and presence of a relative. Practice implications: HCPs shared a lot of information with patients. However, this does not automatically mean that patients will be able to understand and apply this information. HCPs should understand the importance of using cues to enable patient participation. One example is using the teach-back method for verifying patient understanding. It may also be desirable to ensure that a relative is present when discharge information is offered

Poor understanding of allergen labelling by allergic and non‐allergic consumers

Background: Understanding consumers’ interpretation of allergy information is crucial for effective food safety policies. We evaluated consumer understanding of allergy information on foods in controlled, experimental studies. Method: Using 18 packaged foods, we evaluated consumer understanding of information about allergens in two experiments: First, a comparison of foods with no stated allergen versus allergen as a stated ingredient versus a precautionary allergen label (PAL); second, a comparison of three common variants of PAL. In each experiment, consumers with and without self-reported food allergy were asked to estimate the risk of allergic reaction and to rate the comprehensibility of the allergen information. In the second experiment, consumers were also asked which form of PAL they preferred. Results: Risk of reaction was assessed as high and low for foods with the allergen stated as ingredient, or without any mention of allergen. However, risk assessment for PAL varied and was judged as higher by non-allergic than allergic participants (82% vs. 58%, p <.001). Understanding of risk associated with PAL also varied by health literacy (p <.001). Both allergic and non-allergic consumers judged all forms of allergy information to be unclear, especially products with no allergy information for non-allergic consumers. Products with a ‘Produced in a Factory’ PAL were perceived as less risky than ‘May contain’ or ‘Traces of’ PALs (p <.001), less than 40% of participants judged PAL information to be comprehensible, and participants preferred ‘May contain’ over the other PALs. Conclusion: Both allergic and non-allergic consumers find allergen information difficult to interpret on packaged foods and misunderstand PAL, incorrectly distinguishing different risk levels for different PAL wording. Clearer allergy information guidelines are called for, and the use of only one PAL wording is recommended