Simple Interventions Can Reduce Medication Errors

Pictogram-based instruction sheets, "teach-back" approach prove helpful.

As parents prepare to leave hospitals and physicians' offices with their children, clinicians explain how medications should be administered. Studies have shown that, despite these explanations, medication errors are common in children treated at home. These errors include inaccurate dosing and failure to complete prescribed courses.¹ However, recent studies have indicated that people respond well when verbal directions are accompanied by pictorial depictions of instructions and that use of such pictorial depictions can reduce medication errors.

In a randomized controlled trial, Yin and colleagues¹ investigated the efficacy of patient education using pictogram- based medication instruction sheets in a pediatric emergency department that serves many low-income, low-education, and non–English-speaking families. Over approximately 5 months, the researchers enrolled 245 parents who had children between the ages of 30 days and 8 years for whom a liquid medication was prescribed. The parents were randomly assigned either to a control group, which received standard verbal instructions about medication administration, or to an intervention group.

The intervention group received instruction sheets in either English or Spanish that featured information about their prescription illustrated with pictograms; included were pictogram explanations of the indication, dosing, and storage of the medication. A medication log was also provided. Research assistants demonstrated dosing with a standardized instrument and then had parents "teach back" what they had learned. If the medication was not normally dispensed with a standardized dosing instrument, an oral dosing syringe was provided. The total intervention took 11⁄ 2 to 3 minutes to complete.

The participants were assessed at the beginning of the study to gather socioeconomic data and information about regular medication use, as well as to measure their health literacy. After the intervention, they were evaluated for medication adherence, dosing accuracy, and medication knowledge.

The investigators found that participants in the intervention group whose children were prescribed a daily medication were less likely to be mistaken in their understanding of dosing frequency than were those in the control group. There was no difference seen for "as-needed" medications. Parents in the intervention group were less likely to report errors in medication preparation and more likely to report the use of a standardized dosing instrument, for both daily and as-needed medications. When observed by the investigators, parents in the intervention group were less likely to make errors in dosing accuracy with both daily and as-needed medications, even when controlling for use of a standardized dosing instrument. In addition, fewer participants in the intervention group were nonadherent to prescribed medication regimens than were those in the control group.

The Yin study has several limitations, such as use of self-reported data, the grouping together of multiple interventions, and being a non-blind investigation. Further studies are needed to separate out the individual benefits of pictogram use, teach-back methodology, use of a medication log, and provision of a standardized dosing instrument. Nonetheless, pediatricians should consider the findings of the Yin study when prescribing medication. Although use of the teach-back technique would add time to a patient visit, providing parents with a medication log and a pictorial explanation of drug administration would not. By putting some of these practices into action, we can reduce medication errors among our patients.

References:

1.

Yin HS, Dreyer BP, van Schaick L, et al. 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.

2008;162:814-822.