161933 Use of a Low Literacy Pictogram-based Intervention to Reduce Medication Errors in Low SES, Low Education Families: An RCT

Monday, November 5, 2007: 3:15 PM

H. Shonna Yin, MD , Department of Pediatrics, NYU School of Medicine / Bellevue Hospital Center, New York, NY
Benard Dreyer, MD , Department of Pediatrics, NYU School of Medicine / Bellevue Hospital Center, New York, NY
Linda Van Schaick, MS Ed , Department of Pediatrics, The H.E.L.P. Project, NYU School of Medicine / Bellevue Hospital Center, New York, NY
George L. Foltin, MD , Department of Emergency Medicine, NYU School of Medicine / Bellevue Hospital Center, New York, NY
Cheryl Dinglas, BA , Department of Pediatrics, NYU School of Medicine / Bellevue Hospital Center, New York, NY
Alan L. Mendelsohn, MD , Department of Pediatrics, NYU School of Medicine / Bellevue Hospital Center, New York, NY
Background: Liquid medication administration errors are common, and place children at risk for adverse events. Caregivers with low socioeconomic status(SES), low education and low health literacy are at increased risk for errors. Pictogram-based medication instruction and reminder sheets are a promising approach for reducing errors, but have not been well studied.

Objective: To determine whether low SES families receiving a pictogram-based intervention had improved medication knowledge, dosing accuracy, and adherence.

Design/Methods: Enrollment took place in an urban public hospital pediatric emergency service(PES). Inclusion criteria: child 30 days-8 yrs, non-urgent visit, caregiver responsible for giving medications, English/Spanish spoken, liquid medication prescribed. Caregivers were randomized to intervention or control. The intervention consisted of provision and demonstration of: 1)medication-specific pictogram-based instruction and reminder/tracking sheets; 2)oral dosing syringe. Medication knowledge (dose within 20%) and adherence (within 1 day) were assessed by interview, and dosing accuracy (within 20%) was assessed by direct observation at follow-up.

Results: 229 of 245 enrolled caregivers (93.5%) were assessed (124 intervention; 121 control), including 158 prescribed as needed(prn) and 99 prescribed daily dose medications. Intervention and control caregivers were similar for ethnicity, education, SES, and health literacy. Intervention caregivers had improved knowledge of dose (prn: 93.7% vs. 65.8%, p<0.0001; daily: 100% vs. 73.6%, p<0.0001), improved dosing accuracy (prn: 85.9% vs. 61.3%, p=0.002; daily: 94.6% vs. 50.0%, p<0.0001), and improved adherence (daily: 95.3% vs. 63.3%, p<0.0001).

Conclusions: Provision of a pictogram-based intervention resulted in improved medication knowledge, dosing accuracy, and adherence in multiethnic, low SES caregivers presenting to an urban PES.

Learning Objectives:
1. Identify the link between low health literacy and patient/caregiver understanding of medication instructions. 2. Describe the efficacy of a low literacy intervention in improving parent/caregiver understanding of medication instructions.

Keywords: Health Literacy, Health Communications

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.