A Pictogram-Based Intervention to Reduce Parental Liquid Medication Errors: Health Literacy Approach
American Journal of Nursing Science
Volume 2, Issue 3, June 2013, Pages: 27-32
Received: May 31, 2013; Published: Jul. 10, 2013
Views 3802      Downloads 229
Hanan Mohamed Mohamed Tork, Dept of Paediatric Health Nursing, Faculty of Nursing, Zagazig University, Egypt
Article Tools
Follow on us
Evidence suggests that parents and caregivers make frequent errors when administering liquid medications to children. These errors, which include inaccurate dosing as well as non-adherence to medication regimens, place children at risk for morbidity and mortality. The study aim to explore the effectiveness of pictogram based intervention in reducing caregivers’ liquid medication errors as well as the extent to which health literacy impacts medication errors. Quasi-experimental study of caregivers (n=250) of young children (<6 years) enrolled at primary pediatric clinic in Zagazig University hospital. A total of 250 caregivers (121 standard medication counseling and 129 pictogram based intervention) were assessed for health literacy by means of the Newest Vital Sign measure; 84.4%% had low health literacy (Newest Vital Sign score 0-3). Pictogram based intervention recipients were less likely to make errors in knowledge related to medication storage (26.6% vs. 63.3%) dose frequency (20.2% vs. 25%), and preparation compared with caregivers of standard medication counseling recipients (12.8% vs. 31.7%). Pictogram was an efficient way to reduce the prevalence of caregivers' liquid medication errors.
Pictogram, Intervention, Medication Errors, Pediatric Caregiver, Parents, Health Literacy
To cite this article
Hanan Mohamed Mohamed Tork, A Pictogram-Based Intervention to Reduce Parental Liquid Medication Errors: Health Literacy Approach, American Journal of Nursing Science. Vol. 2, No. 3, 2013, pp. 27-32. doi: 10.11648/j.ajns.20130203.12
Mehndiratta S (2012): Strategies to reduce medication errors in pediatric ambulatory settings. Journal of Postgraduate Medicine. 58:47-53.
Zandieh SO, Goldmann DA, Keohane CA, Yoon C, Bates DW, Kaushal R. (2008): Risk factors in preventable adverse drug events in pediatric outpatients. J Pediatr. 152(2):225-231.
Frush KS, Luo X, Hutchinson P, Higgins JN. (2004): Evaluation of a method to reduce over-the-counter medication dosing error. Arch Pediatr Adolesc Med. 158(7):620-624.
Hämeen-Anttila K., Honkanen L., and Vainio K. (2009): The usability of medicine education assignments for seven to nine year-old children. Health Educ. 109, 491–506.
Antonow, J., Smith, A., & Silver, M. (2000): Medication error reporting: A survey of nursing staff. Journal of Nursing Care Quality. 15, 42−48.
Quinzler R, Gasse C, Schneider A, et al. (2006): The frequency of inappropriate tablet splitting in primary care. Eur J Clin Pharmacol. 62:1065-73.
Sobhani P, Christopherson J, Ambrose PJ, et al. (2008): Accuracy of oral liquid measuring devices: comparison of dosing cup and oral dosing syringe. Ann Pharmacother. 42:46-52.
Kaushal R, Bates DW, Landrigan C, et al. (2001): Medication errors and adverse drug events in pediatric inpatients. JAMA. 285:2114-20.
Yin HS, Alan L, Mendelsohn AL, Wolf MS, Parker RM, Fierman A, Schaick LV.; Bazan IS.; Kline; Dreyer BP. (2010): Parents’ Medication Administration Errors: Role of Dosing Instruments and Health Literacy. Arch Pediatr Adolesc Med. 2010; 164(2):181-186.
Bertsche T, Bertsche A., Krieg,N Kunz, K Bergmann, Hanke G. Hoppe-Tichy T. Ebinger F. WE Haefeli WE. (2010): Prospective pilot intervention study to prevent medication errors in drugs administered to children by mouth or gastric tube: a programme for nurses, physicians and parents. Qual Saf Health Care. 19-26.
Krähenbühl-Melcher A, Schlienger R, Lampert M, et al. (2007): Drug-related problems in hospitals: a review of the recent literature. Drug Saf. 30:379-407.
Alexander DC, Bundy DG, Shore AD, et al. (2009): Cardiovascular medication errors in children. Pediatrics. 124:324-32.
Yin HS, Mendelsohn AL, Fierman A, et al. (2011): Use of a pictographic diagram to decrease parent dosing errors with infant acetaminophen: a health literacy perspective. Acad Pediatr.11:50–57.
[14] Patanwala IM, Brocklebank V, Inglis J. Trewby PN. A randomized questionnaire based study on the impact of providing numerical information on colorectal cancer screening. J R Soc Med Sh Rep 2011; 2:48.
Hämeen-Anttila K, Kemppainen K, Enlund H, Patricia JB, Marja A. Do pictograms improve children’s understanding of medicine leaflet information? Patient Education and Counseling 55 (2004) 371–378.
[16] Mansoor LE, Dowse R. Effect of pictograms on readability of patient information materials. Ann Pharmacother 2003;37: 1003–9.
United States Pharmacopeial Convention Inc. USP Pictograms. Retrieved 21 March 2012 from http://www.usp.org/].
Yin HS., Dreyer BP., Schaick L., Foltin GL., Dinglas C., Mendelsohn AL.(2008): Randomized Controlled Trial of a Pictogram-Based Intervention to Reduce Liquid Medication Dosing Errors and Improve Adherence Among Caregivers of Young Children. Arch Pediatr Adolesc Med. 162(9):814-822.
Berkman N, DeWalt D, Pignone M, et al. (2004): Literacy and health outcomes. Summary, evidence report/technology assessment no. 87. Rockville, MD: Agency for Healthcare Research and Quality.
Schwartzberg JG, Van Geest JB, Wang CC, eds. (2005): Understanding Health Literacy: Implications for Medicine and Public Health. Chicago, Ill: AMA Press.
Lee SD, Tsai T, Tsai Y and Kuo KN. (2010): Health literacy, health status, and healthcare utilization of Taiwanese adults: results from a national survey. BMC Public Health. 10:614.
King JP, Davis TC, Bailey SC, et al. (2011): Developing Consumer-Centered, Nonprescription Drug Labeling: A Study in Acetaminophen. American Journal of Preventive Medicine. 40(6):593-598.
Rothman RL, Yin HS, Mulvaney S, Co JP, Homer C, Lannon C. (2009): Health literacy and quality: focus on chronic illness care and patient safety. Pediatrics.124 (3):S315-326.
Bailey S, Agarwal N, Sleath B, Gumusoglu S. (2011): Improving Drug Labeling and Counseling for Limited English Proficient Adults. Journal of Health Care for the Poor and Underserved. 22(4):1131-1143.
Weiss L, Gany F, Rosenfeld P, et al. (2007): Access to Multilingual Medication Instructions at New York City Pharmacies. Journal of Urban Health. 84(6):742-754.
DeWalt DA and Hink A (2009): Health Literacy and Child Health Outcomes: A Systematic Review of the Literature. Pediatrics. 124; S265.
DeWalt DA, and Pignone MP. (2005): Reading is fundamental: the relationship between literacy and health. Arch Intern Med. 165(17): 1943–1944.
DeWalt DA, Berkman ND, Sheridan SL, Lohr KN, Pignone M. (2004): Literacy and health outcomes: a systematic review of the literature. J Gen Intern Med. 19(12):1228–1239.
American Academy of Pediatrics (2003): Prevention of medication errors in the inpatient setting. Pediatrics. 112: 431-436.
McPhillips HA, Stille CJ, Smith D, et al. (2005): Potential medication dosing errors in outpatient pediatrics. J Pediatr. 147: 761-767.
Slonim DA, LaFleur BJ, Ahmed W, et al. (2003): Hospital-reported medical errors in children. Pediatrics. 111: 617-621.
Weiss BD, Mays MZ, Martz W, et al. (2005): Quick assessment of literacy in primary care: the newest vital sign. Annals of Family Medicine. 3(6):514-522.
Katz MG, Kripalani S, Weiss BD. Use of pictorial aids in medication instructions: a review of the literature. Am J Health-System Pharmacy. 2006;63:2391–2396.
Dowse R, Ehlers M. Medicine labels incorporating pictograms: do they influence understanding and adherence? Patient Educ Couns. 2005;58:63–70.
Nielsen-Bohlman LT, Panzer AM, Kindig DA, eds. Health literacy: A prescription to end confusion. 1st ed. Washington, DC: National Academies Press; 2004.
Wagner C, Knight K, Steptoe A, Wardle J: Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health 2007, 61(12): 1086-1090.
Kutner M, Greenberg E, Yin J, Paulsen C, White S: The health literacy of America’s adults: Results from the 2003 national assessment of adult literacy. US Department of Education. Washington, DC 2006.
UNICEF (2010): Information by country and programme. Retrieved 15 May 2012 from [http://www.unicef.org/infobycountry/egypt_statistics].
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
Tel: (001)347-983-5186