Pictogram-based instructions reduce home medication errors among pediatric caregivers: A randomized controlled trial

Background Medication errors with liquid pediatric formulations are a pressing patient safety concern. This study evaluated the effectiveness of a pictogram-based instruction package in reducing home medication errors made by caregivers compared with a text-based instruction label. Methods This randomized controlled trial (RCT) recruited 134 caregivers of children prescribed reconstitutable oral antibiotics using convenience sampling. Participants were randomly assigned to receive either pictogram-based instructions (intervention group) or standard text-only labels with verbal explanation (control group). Drug reconstitution errors were directly observed, while potential administration errors were self-reported. Caregiver label preferences were also evaluated. Outcomes between the groups were compared using Chi-square tests, and risk ratios (RR) were calculated to determine the intervention's effect size. Results The pictogram-based intervention led to a significant reduction in medication errors. The intervention group (n = 69) had substantially fewer reconstitution errors compared to the control group (n = 65) (21.7% vs. 84.6%; risk ratios (RR) = 0.26, 95% confidence interval (CI): 0.16–0.41, p < 0.001) and fewer self-reported potential administration errors (8.7% vs. 84.6%; RR = 0.10, 95% CI: 0.05–0.22, p < 0.001). Notably, errors related to incorrect water volume and misinterpreted dosing intervals and duration were significantly reduced. Over 92% of caregivers in both groups expressed a strong preference for instructions combining pictograms with text, citing improved clarity and ease of understanding. Conclusion In this RCT, a pictogram-based instruction package was a highly effective and simple risk management tool that significantly reduced caregiver medication errors. Its implementation is a promising strategy to enhance medication safety and adherence in diverse pediatric populations.