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Carers use of pictograms reduces dosing errors and improves adherence in children (POEM)

Clinical question: Do pictograms help reduce medicine dosing errors by carers of children?

Clinical question Do pictograms help reduce medicine dosing errors by carers of children?

Bottom line Compared with usual care, carers of children who use pictogram-based instructions have better knowledge about the prescribed medicines, are less likely to make dosing errors and are more likely to be adherent to the treatment instuctions.

Synopsis This study took place in a paediatric emergency department serving a population of patients with mostly low education levels.

Caregivers of 245 children aged between 30 days and eight years who were prescribed liquid medicines (daily dose or as needed) were randomly assigned (allocation concealed) to usual care or to the intervention that consisted of plain language (English or Spanish), pictogram-based instruction sheets coupled with counselling by trained research assistants.

The pictograms communicated the medicine’s name, dosing instructions and duration of treatment, and the sheets provided a log for tracking medicine administration. The intervention took less than five minutes.

The research assistants contacted the caregivers after enrolment (3–5 days after enrolment for as-needed medicines; within one day of the anticipated last day of use for daily use medicines). The research assistants assessed whether the caregivers knew the name of the medicine and dosing frequency.

Additionally, the research assistants assessed dosing accuracy by directly observing the caregivers administer the medicines. Finally, the researchers estimated adherence on the basis of the percentage of medicine doses given. There was no difference in the ability to name the medicine or its indication.

However, the caregivers in the pictogram-based group made fewer factual errors about medicine frequency and preparation.

More importantly, the caregivers in the intervention group were more likely to administer medicines accurately than those in the usual care group (number needed to treat [NNT] = 2–11) and to be adherent to the prescribed regimen (NNT = 2–12).

Level of evidence 2b (low-quality randomised control trial)

Reference Yin HS, Dreyer BP, van Schaick L, Foltin GL, Dinglas C, Mendelsohn AL. Randomised controlled trial of a pictogram-based intervention to reduce liquid medicine dosing errors and improve adherence among caregivers of young children. Archives of Pediatrics and Adolescent Medicine 2008;162(9):814-822.


POEM (Patient Oriented Evidence that Matters) © 1995-2008 John Wiley &Sons, Inc. or related companies. All Rights reserved.

Citation: The Pharmaceutical Journal URI: 10041312

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