Abstract
Objective Patient instructions are generally written by clinicians. However, clinician-centered
language is challenging for patients to understand; in the case of pediatric medication
instructions, consequences can be serious. Using examples of clinician-written medication
instructions from an electronic health record, we conducted an experiment to determine
whether parental misinterpretations would be reduced by instructions that followed
best practices for plain language.
Methods We selected examples of dosing instructions from after-visit summaries in a commercial
electronic health record. A demographically diverse sample of parents and adult caregivers
was recruited from an online panel to participate in an English-language experiment,
in which they received a comprehension questionnaire with either original after-visit
summary instructions or instructions revised to comply with federal and other sources
of plain-language guidance.
Results Nine-hundred and fifty-one respondents completed the experiment; 50% were women,
the mean age was 36 years, and 38% had less than a 4-year college education. The revisions
were associated with an 8 percentage point increase in correct answers overall (from
55% to 63%, p < 0.001), although revisions were not equally effective for all instructions. Health
literacy and health numeracy were strong and independent predictors of comprehension.
Overall, mistakes on comprehension questions were common, with respondents missing
an average of 41% (6.1 of 15) of questions.
Conclusion In this experimental study, a relatively simple intervention of revising text was
associated with a modest reduction in frequency of misinterpretations of medication
instructions. As a supplement to more intensive high-touch interventions, revising
electronic health record output to replace complex language with patient-centered
language in an automated fashion is a potentially scalable solution that could reduce
medication administration errors by parents.
Keywords
health literacy - pediatrics - drug overdose - medication errors - survey and questionnaires
