title: Randomized controlled trial of a pictogram-based intervention to reduce liquid medication dosing errors and improve adherence among caregivers of young children.
abstract: OBJECTIVE
  To evaluate the efficacy of a pictogram-based health literacy intervention to decrease liquid medication administration errors by caregivers of young children.
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Urban public hospital pediatric emergency department.
  
  
  METHODS
  Parents and caregivers (N = 245) of children aged 30 days to 8 years who were prescribed liquid medications (daily dose or "as needed").
  
  
  METHODS
  Medication counseling using plain language, pictogram-based medication instruction sheets. Control subjects received standard medication counseling.
  
  
  METHODS
  Medication knowledge and practice, dosing accuracy, and adherence.
  
  
  RESULTS
  Of 245 randomized caregivers, 227 underwent follow-up assessments (intervention group, 113; control group, 114). Of these, 99 were prescribed a daily dose medication, and 158 were prescribed medication taken as needed. Intervention caregivers had fewer errors in observed dosing accuracy (>20% deviation from prescribed dose) compared with caregivers who received routine counseling (daily dose: 5.4% vs 47.8%; absolute risk reduction [ARR], 42.4% [95% confidence interval, 24.0%-57.0%]; number needed to treat [NNT], 2 [2-4]; as needed: 15.6% vs 40.0%; ARR, 24.4% (8.7%-38.8%); NNT, 4 [3-12]). Of intervention caregivers, 9.3% were nonadherent (ie, did not give within 20% of the total prescribed doses) compared with 38.0% of controls (ARR, 28.7% [11.4%-43.7%]; NNT, 3 [2-9]). Improvements were also seen for knowledge of appropriate preparation for both medication types, as well as knowledge of frequency for those prescribed daily dose medications.
  
  
  CONCLUSIONS
  A plain language, pictogram-based intervention used as part of medication counseling resulted in decreased medication dosing errors and improved adherence among multiethnic, low socioeconomic status caregivers whose children were treated at an urban pediatric emergency department.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT00537433.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, 550 First Ave, NBV 8S4-11, New York, NY 10016, USA. yinh02@med.nyu.edu
authors.forename: H Shonna
authors.initials: HS
authors.lastname: Yin
authors.forename: Benard P
authors.initials: BP
authors.lastname: Dreyer
authors.forename: Linda
authors.initials: L
authors.lastname: van Schaick
authors.forename: George L
authors.initials: GL
authors.lastname: Foltin
authors.forename: Cheryl
authors.initials: C
authors.lastname: Dinglas
authors.forename: Alan L
authors.initials: AL
authors.lastname: Mendelsohn