Pictograms for Safer Medication Management by Health Care Workers.
BACKGROUND
Inherent risks are associated with the preparation and administration of medications. As such, a key aspect of medication safety is to ensure safe medication management practices.


OBJECTIVE
To identify key medication safety issues and high-alert drug classes that might benefit from implementation of pictograms, for use by health care providers, to enhance medication administration safety. This study was the first step in the development of such pictograms.


METHODS
Self-identified medication management experts participated in a modified Delphi process to achieve consensus on situations where safety pictograms are required for labelling to optimize safe medication management. The study was divided into 3 phases: issue generation, issue reduction, and issue selection. Issues achieving at least 80% consensus and deemed most essential were selected for future studies. Retained issues were subjected to semiotic analysis, and preliminary pictograms were developed.


RESULTS
Of the 87 health care professionals (pharmacists, pharmacy technicians, nurses, and physicians) invited to participate in the Delphi process, 30 participated in all 3 phases. A total of 55 situations that could potentially benefit from safety pictograms were generated initially. Through the Delphi process, these were narrowed down to 10 situations where medication safety might be increased with the use of safety pictograms. For most of the retained issues, between 3 and 6 pictograms were designed, based on the results of the semiotic analysis.


CONCLUSIONS
The pharmacists, pharmacy technicians, nurses, and physicians participating in this study reached consensus and identified 10 medication administration safety issues that might benefit from the development and implementation of safety pictograms. Pictograms were developed for a total of 9 issues. In follow-up studies, these pictograms will be validated for comprehension and evaluated for effectiveness.
, PharmD, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
Régis
R
Vaillancourt
, PhD, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
Annie
A
Pouliot
, RN, is with the Institute for Safe Medication Practices Canada (ISMP Canada), Toronto, Ontario.
Kim
K
Streitenberger
, BScPhm, MHSc, is with the Institute for Safe Medication Practices Canada (ISMP Canada), Toronto, Ontario.
Sylvia
S
Hyland
, BSc, is with the Children's Hospital of Eastern Ontario, Ottawa, Ontario.
Pierre
P
Thabet
Delphi process; health care worker; medication error; medication safety; pictogram