Women’s Understanding of Different Dosing Instructions for a Liquid Pediatric Medication

Wallace, Lorraine S.; Keenum, Amy J.; DeVoe, Jennifer E.; Bolon, Shannon; Hansen, Julie Schjødtz

doi:10.1016/j.pedhc.2011.06.006

Cited by 23 publications

(21 citation statements)

References 21 publications

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“…Wrong dosing of paediatric liquid medications is exceedingly common, with a considerable proportion of caregivers (10–90%) measuring the doses incorrectly . Generally, the use of calibrated oral syringes caused fewer errors as compared with other devices including dosing cups, household spoons and droppers .…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…12 Wrong dosing of paediatric liquid medications is exceedingly common, with a considerable proportion of caregivers (10-90%) measuring the doses incorrectly. [13][14][15][16][17][18] Generally, the use of calibrated oral syringes caused fewer errors as compared with other devices including dosing cups, household spoons and droppers. [14][15][16][17]19,20 However, Yin et al 16 found that approximately 25% of the caregivers in a New York public hospital measured liquid medications with deviations of greater than 40% from prescribed doses, despite the measuring devices used.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…5,19,[21][22][23] Although the majority of caregivers claimed that written instructions were read and followed, nearly 30-60% of them still had difficulty in indicating the correct dosing frequency and intervals for liquid medications. 13,19,[23][24][25] Previous studies also demonstrated a lack of knowledge among the caregivers about the product stability and correct steps to reconstitute medications from powder to liquid form. 26,27 Another challenging issue in medication administration is the adherence of caregivers.…”

Section: What Is Known and Objectivementioning

confidence: 99%

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

et al. 2015

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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.

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Section: What Is Known and Objectivementioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

Section: What Is Known and Objectivementioning

confidence: 99%

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

et al. 2015

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“…First, a large proportion of American adults-more than 50%-have basic or below basic quantitative numeracy skills. 1 Second, adequate numeracy skills are required to successfully execute many health-related tasks, including calculating medication dosing intervals [7][8][9] ; interpreting medication and food labels 10,11 ; deciphering charts (eg, growth, body mass index) 12 ; and weighing the risks and benefits needed to make informed decisions related to health care. 13,14 While valid and reliable HL assessment tools are available, several factors preclude their use in routine clinical practice.…”

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confidence: 99%

Brief Health Literacy Screening Items Predict Newest Vital Sign Scores

Stagliano

Wallace

2013

The Journal of the American Board of Family Medicine

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Background: Numeracy is an important but understudied component of health literacy (HL). The purpose of this study was to examine the predictive ability of established general HL and numeracy screening items in estimating Newest Vital Sign (NVS) scores.Methods: We studied 241 adults attending primary care clinics in the midwestern United States. Demographic items, HL screening questions, and the NVS were administered to patients. To determine the accuracy of HL and numeracy screening items, area under the receiver operating characteristic (AUROC) curves were determined for each screening item, using NVS scores as the reference standard.Results

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“…57,58 Covariates For all participants, health literacy was assessed with the three-item Chew scale. 59,60 Following Wallace et al, 61 we assigned 1 point to each question for which the participant answered that they had any difficulty or required help, to produce a health literacy score of 0 (adequate), 1 (marginal), or 2 or 3 (inadequate). Health numeracy was assessed with the 8-item Short Numeracy Understanding in Medicine Instrument (S-NUMi).…”

Section: Questionnaire Developmentmentioning

confidence: 99%

Health IT Usability Focus Section: Adapting EHR-Based Medication Instructions to Comply with Plain Language Guidance—A Randomized Experiment

et al. 2017

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Objective Patient instructions are generally written by clinicians. However, clinician-centered language is challenging for patients to understand; in the case of pediatric medication instructions, consequences can be serious. Using examples of clinician-written medication instructions from an electronic health record, we conducted an experiment to determine whether parental misinterpretations would be reduced by instructions that followed best practices for plain language. Methods We selected examples of dosing instructions from after-visit summaries in a commercial electronic health record. A demographically diverse sample of parents and adult caregivers was recruited from an online panel to participate in an English-language experiment, in which they received a comprehension questionnaire with either original after-visit summary instructions or instructions revised to comply with federal and other sources of plain-language guidance. Results Nine-hundred and fifty-one respondents completed the experiment; 50% were women, the mean age was 36 years, and 38% had less than a 4-year college education. The revisions were associated with an 8 percentage point increase in correct answers overall (from 55% to 63%, p< 0.001), although revisions were not equally effective for all instructions. Health literacy and health numeracy were strong and independent predictors of comprehension. Overall, mistakes on comprehension questions were common, with respondents missing an average of 41% (6.1 of 15) of questions. Conclusion In this experimental study, a relatively simple intervention of revising text was associated with a modest reduction in frequency of misinterpretations of medication instructions. As a supplement to more intensive high-touch interventions, revising electronic health record output to replace complex language with patient-centered language in an automated fashion is a potentially scalable solution that could reduce medication administration errors by parents.

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Women’s Understanding of Different Dosing Instructions for a Liquid Pediatric Medication

Cited by 23 publications

References 21 publications

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

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

Brief Health Literacy Screening Items Predict Newest Vital Sign Scores

Health IT Usability Focus Section: Adapting EHR-Based Medication Instructions to Comply with Plain Language Guidance—A Randomized Experiment

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