Pictograms, units and dosing tools, and parent medication errors: A randomized study

H. Shonna Yin*, Ruth M. Parker, Lee M. Sanders, Alan Mendelsohn, Benard P. Dreyer, Stacy Cooper Bailey, Deesha A. Patel, Jessica J. Jimenez, Kwang Youn A. Kim, Kara Jacobson, Michelle C.J. Smith, Laurie Hedlund, Nicole Meyers, Terri McFadden, Michael S. Wolf

*Corresponding author for this work

Research output: Contribution to journalArticle

19 Scopus citations

Abstract

BACKGROUND AND OBJECTIVES: Poorly designed labels and dosing tools contribute to dosing errors. We examined the degree to which errors could be reduced with pictographic diagrams, milliliter-only units, and provision of tools more closely matched to prescribed volumes. METHODS: This study involved a randomized controlled experiment in 3 pediatric clinics. English-and Spanish-speaking parents (n = 491) of children ≤8 years old were randomly assigned to 1 of 4 groups and given labels and dosing tools that varied in label instruction format (text and pictogram, or text only) and units (milliliter-only ["mL"] or milliliter/teaspoon ["mL/tsp"]). Each parent measured 9 doses of liquid medication (3 amounts [2, 7.5, and 10 mL] and 3 tools [1 cup, 2 syringes (5-and 10-mL capacities)]) in random order. The primary outcome was dosing error (>20% deviation), and large error (>2× dose). RESULTS: We found that 83.5% of parents made ≥1 dosing error (overdosing was present in 12.1% of errors) and 29.3% of parents made ≥1 large error (>2× dose). The greatest impact on errors resulted from the provision of tools more closely matched to prescribed dose volumes. For the 2-mL dose, the fewest errors were seen with the 5-mL syringe (5-vs 10-mL syringe: adjusted odds ratio [aOR] = 0.3 [95% confidence interval: 0.2-0.4]; cup versus 10-mL syringe: aOR = 7.5 [5.7-10.0]). For the 7.5-mL dose, the fewest errors were with the 10-mL syringe, which did not necessitate measurement of multiple instrumentfulls (5-vs 10-mL syringe: aOR = 4.0 [3.0-5.4]; cup versus 10-mL syringe: aOR = 2.1 [1.5-2.9]). Milliliter/teaspoon was associated with more errors than milliliter-only (aOR = 1.3 [1.05-1.6]). Parents who received text only (versus text and pictogram) instructions or milliliter/teaspoon (versus milliliter-only) labels and tools made more large errors (aOR = 1.9 [1.1-3.3], aOR = 2.5 [1.4-4.6], respectively). CONCLUSIONS: Provision of dosing tools more closely matched to prescribed dose volumes is an especially promising strategy for reducing pediatric dosing errors.

Original languageEnglish (US)
Article numbere20163237
JournalPediatrics
Volume140
Issue number1
DOIs
StatePublished - Jul 2017

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Yin, H. S., Parker, R. M., Sanders, L. M., Mendelsohn, A., Dreyer, B. P., Bailey, S. C., Patel, D. A., Jimenez, J. J., Kim, K. Y. A., Jacobson, K., Smith, M. C. J., Hedlund, L., Meyers, N., McFadden, T., & Wolf, M. S. (2017). Pictograms, units and dosing tools, and parent medication errors: A randomized study. Pediatrics, 140(1), [e20163237]. https://doi.org/10.1542/peds.2016-3237