Using pictograms to assist caregivers in liquid medication administration: a systematic review

Abstract

SUMMARYWhat is known and objective: It has been reported that more than 80% of out-of-hospital medication errors among the young children involve liquid formulations. The usefulness of pictorial aids to improve communication of medication instructions has not been extensively investigated for child health. The objective of this study was to determine the effectiveness of pictorial aids used to assist caregivers in the administration of liquid medications. Methods: MEDLINE, CINAHL, PsycINFO, ScienceDirect, Scopus and the Cochrane Library were searched for articles published up to February 2015. Studies that used pictorial aids with liquid medications and measured at least one of the following outcomes were included: dosing accuracy, comprehension of medication instructions, recall of information and adherence of caregivers. Two authors independently selected studies, extracted data and assessed methodological quality of studies using the Cochrane Collaboration's tool. Results and discussion: Five experimental studies (four hospital based and one community based) with a total of 962 participants were included. A wide range of liquid formulations were studied, including both prescription and over-the-counter medications. The existing findings suggest that pictographic interventions reduced dosing errors, enhanced comprehension and recall of medication instructions and improved adherence of caregivers. Incorporating pictorial aids into verbal medication counselling or text-based instructions was more beneficial than using the single approach alone. Mixed results were identified for the relationship between health literacy of caregivers and effectiveness of pictorial aids. What is new and conclusion: The evidence remains limited due to the small number of studies found and variations in methodological quality. This review suggests that pictorial aids might be potential interventions, but more high-quality studies are needed to support the routine use of any pictogram-based materials with liquid medications in the clinical settings. WHAT IS KNOWN AND OBJECTIVELiquids are often the preferred form of oral medication delivery for young children and infants. These formulations are usually combined with pleasant-tasting excipients and easier to swallow.

Pediatric Medication Safety in the Emergency Department

“…71 Pictograms provided to aide in medication measurement have also been shown to decrease errors and may be considered as part of discharge instructions. 72 The AAP supports policy on the use of milliliter-only dosing for liquid medications used in the home and suggests that standardized delivery devices be distributed from the ED for use with these medications. 73 As the body of literature regarding health literacy evolves, further addressing these issues in real time may influence outof-hospital care.…”

Influences of pictogram-based instructions in paediatric drug labelling on dosing accuracy among caregivers: a pilot study from Malaysia

“…This pilot study adds to the existing literature on the usefulness of pictorial aids for assisting children's caregivers in liquid medication administration. Different from previous studies focusing mainly on the use of pictograms in medication instruction sheets, it investigated the influences of pictographic dosing instructions incorporated into a drug label, which requires information to be presented with simplicity. The findings suggest that using a pictogram to illustrate volume to measure in a drug label reduces errors among children's caregivers when dosing liquid medications, consistent with those of similar studies that evaluated dosing accuracy …”

“…Pictorial aids might be a potential intervention to improve health communication, but their usefulness in paediatric medicine has been less intensively investigated . The aim of this pilot study was to determine the influences of pictogram‐based instructions, which were incorporated into a computer‐generated label, on dosing accuracy among the children's caregivers.…”

Improving pediatric liquid medication labeling of the hospital information system in Malaysia: qualitative analysis of pharmacists’ perceptions

“…Effectiveness of pictographs incorporated into written instructions to improve medication safety is supported by the existing literature; however, it is important to avoid the use of complex images. 36 , 37 , 38 …”