One of the pictogram instructions created by HELPix.

Not long ago, parents in the pediatric clinic at Bellevue were seen clutching paper towels with crude drawings of medicine droppers that well-meaning doctors had given them to show how much medicine they should give their child.  Many could not understand their doctor’s instructions or remember the details of how to give prescribed medications because of limited language skills or just plain anxiety about their children's health.

But with HELPix, a new system that illustrates directions with easy-to-understand graphics, Bellevue staff is starting to help parents give their children the right dose of medication at the right time, and for the prescribed number of days. 

"We knew there had to be a better way to help parents avoid dosing errors and other potentially dangerous medication mistakes," says Linda van Schaick, a child development and health literacy specialist at Bellevue.  "The graphics we share and the simple bilingual words we use can be universally understood in each language and effectively communicate the message at-a-glance."

HELPix, an intervention of the Health Education and Literacy for Parents (HELP) Project, features standardized picture-based instruction sheets that were created by a team that included specialists in pediatric medicine, pharmaceutical safety, parent education, multi-lingual communication and even graphic design. A picture of a hand moving a medicine bottle indicates "shake well."  A medicine dropper against a sun and a moon indicates "take twice a day."  A graphic of drugs stored high above a cabinet tells parents to "keep out of reach of children."  And most importantly, a picture of a medicine dropper filled to the correct "line" shows parents exactly how much medicine to give. 

"Parents in the clinic were also partners in this project," added van Schaick.  "We checked with them frequently to make sure that each image was the best way to communicate an idea."

The HELPix Bellevue team, lead by Dr. Benard P. Dreyer, Director of Pediatrics and Pediatrician  Dr. Shonna Yin, tested the first set of graphic instructions in a randomized controlled trial study to learn whether the new communication method really worked.

The trial showed that by using the specially developed instruction sheets, 95 percent of parents whose children were prescribed daily medications, like antibiotics, were able to administer the correct dose compared to 52 percent of the parents who did not get HELPix.  And more than 90 percent of the parents who used the illustrations were able to give the medication for the length of time and at the frequency prescribed by the doctor, compared to 62 percent of those without HELPix.

The HELPix project won grand prize at HHC's 2009 Patient Safety Expo, the annual event that showcases the most outstanding patient safety and quality projects in New York City public hospitals.  Dr. Yin has also presented the project's results at numerous professional conferences sponsored by widely respected national healthcare organizations such as the federal Agency for Healthcare Research and Quality and the United Hospital Fund.  The Joint Commission, a premier accreditation organization for hospitals nationwide, featured the system in a detailed case study it published this year.

The HELPix team is now preparing a web-based computer program that will print instruction sheets, customized for each patient, in English and Spanish.  The rollout of the computer program in Bellevue is planned to begin in early 2010.  This project is slated to eventually be expanded to other languages and to other HHC pediatric facilities.

October 2009