Can use of pictograms reduce liquid medication administration errors by mothers? An interventional study

Abstract

Background Liquid medication dosing errors (LMDE) made by caregivers affect treatment in children, but this is not a well-studied topic in many low-and middle-income countries including in India. Methods An intervention study was conducted among mothers attending a pediatric outpatient clinic of a tertiary care setting in Ujjain, India. The mothers randomly measured 12 volumes of a paracetamol liquid preparation by using a dropper (0.5 and 1 mL), measuring cup (2.5 and 5 mL), and calibrated spoon (2.5 and 5 mL) each with two instructions—oral-only measurement session (OMS) and oral plus pictogram measurement session (OPMS, the intervention). The main outcome was dosing error prevalence. The effectiveness of the intervention was assessed by measuring effect size. Risk factors for maximum LMDE were explored using backward multivariate logistic regression models. A P value of < 0.05 was considered statistically significant. Results In total, 310 mothers [mean (± SD) age, 30.2 (± 4.18) years] were included. LMDE prevalence in the OMS versus OPMS for dropper 0.5 mL was 60% versus 48%; for l mL dropper was 63% versus 54%; for 2.5 mL cup 62% versus 54%; for 2.5 calibrated spoon 66% versus 59%; 5 mL cup 69% versus 57%; and 5 mL calibrated spoon 68% versus 55%. Comparing OMS with OPMS, underdosing was minimum with the calibrated spoon for 2.5 mL (OR 4.39) and maximum with the dropper for 1 mL (OR 9.40), and overdosing was minimum with the dropper for 0.5 mL (OR 7.12) and maximum with the calibrated spoon for 2.5 mL (OR 13.24). The effect size (dCohen) of the intervention OPMS was 1.86–6.4. Risk factors for the most prevalent dosing error, that is, with the calibrated spoon for 2.5 mL, were increasing age of the mother (aOR 1.08; P = 0.026) and nuclear family (aOR 2.83; P = 0.002). The risk of dosing errors decreased with higher education of the mothers. Conclusions Pictograms can effectively minimize LMDE even in less educated mothers.

Evaluation of knowledge, attitude, and perception of pictograms in improving understanding of foreign medicine packages and leaflets among Malaysians

“…In addition, most of the respondents in the present study agreed that the usage of pictograms can reduce medication errors, which aligns with a study conducted by Patidar et al (2020). This study demonstrated that pictogram interventions reduced dosing errors among mothers with poor health literacy when administering liquid medication to children by approximately 48 to 54% and improved the mothers' understanding of dosing (Chan et al, 2015;Patidar et al, 2021). Therefore, pictograms are being utilized in patient counselling within pharmacy settings to enhance compliance and medication safety (Merks et al, 2021;Vaillancourt et al, 2019).…”

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“…In addition, most of the respondents in the present study agreed that the usage of pictograms can reduce medication errors, which aligns with a study conducted by Patidar et al (2020). This study demonstrated that pictogram interventions reduced dosing errors among mothers with poor health literacy when administering liquid medication to children by approximately 48 to 54% and improved the mothers' understanding of dosing (Chan et al, 2015;Patidar et al, 2021). Therefore, pictograms are being utilized in patient counselling within pharmacy settings to enhance compliance and medication safety (Merks et 139 al., 2021;Vaillancourt et al, 2019).…”

Health literacy in pediatric dermatology: challenges and opportunities

“…Several studies have shown promising interventions to help alleviate medication administration errors, including among patients and parents/guardians having limited health literacy levels. Medication errors can be minimized in parents/guardians with both lower and higher health literacy by using pictograms in addition to verbal medication counseling [35,36]. A study looking at delivering complex medication regimens for neonatal patients found that collaboration between parents/guardians, medical professionals, and manufacturers led to the creation of health literature and drug packaging that significantly decreased medication administration errors [37 ▪ ].…”