{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T13:30:07Z","timestamp":1789047007850,"version":"build-2803163510"},"reference-count":33,"publisher":"Walter de Gruyter GmbH","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009633","name":"Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health","doi-asserted-by":"crossref","award":["R01HD094793"],"award-info":[{"award-number":["R01HD094793"]}],"id":[{"id":"10.13039\/100009633","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"crossref","award":["T32HS026121"],"award-info":[{"award-number":["T32HS026121"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Wrong-patient errors cause serious harm in newborns. These errors involve ordering and administering tests, procedures, medications, and breast milk to an unintended patient. Newborns receiving care in neonatal intensive care units (NICUs) are at particularly high risk. Although more distinct newborn naming conventions as recommended by the Joint Commission significantly reduce wrong-patient orders, name similarities among multiple-birth infants and truncation of differentiating information in some electronic health record (EHR) systems contribute to this persistent increased risk. Accordingly, novel newborn identifiers are urgently needed. We propose Pictographs\u00a0\u2013\u00a0images that are appealing, recognizable, and appropriate\u00a0\u2013\u00a0to serve as visual identifiers for newborns in NICUs. Pictographs are selected by caregivers, uploaded into the EHR, and displayed at bedside. As part of a multicenter randomized controlled trial assessing effectiveness of Pictographs to prevent wrong-patient order errors, we initially evaluated feasibility and acceptability of Pictographs at two study sites. Pictographs as novel visual identifiers for newborns in the NICU were generally well received by caregivers and clinicians, and the vast majority of caregivers selected a Pictograph for their infant(s), which was posted at the bedside and uploaded into the EHR. Ordering clinicians\u00a0\u2013\u00a0the primary target of the intervention to prevent wrong-patient errors\u00a0\u2013\u00a0recognized the potential for Pictographs to provide a visual cue when placing orders, particularly for multiple-birth infants. Here, we describe the rationale, implementation, framework, feasibility, usefulness, and acceptability of Pictographs among key stakeholders. If found effective for preventing wrong-patient errors, Pictographs could be adopted as a patient safety solution in hospitals worldwide.<\/jats:p>","DOI":"10.1515\/jpm-2026-0027","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T09:56:31Z","timestamp":1784022991000},"page":"1087-1094","source":"Crossref","is-referenced-by-count":0,"title":["Pictographs: feasibility and acceptability of a novel method of newborn identification to reduce wrong-patient errors in the NICU"],"prefix":"10.1515","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7497-257X","authenticated-orcid":false,"given":"Jason S.","family":"Adelman","sequence":"first","affiliation":[{"name":"Department of Medicine , Columbia University Irving Medical Center , Vagelos College of Physicians and Surgeons , New York , NY , USA"},{"name":"Center for Patient Safety Science , Columbia University , New York , NY , USA"},{"name":"Department of Quality and Patient Safety , NewYork-Presbyterian Hospital , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4137-6069","authenticated-orcid":false,"given":"Jo R.","family":"Applebaum","sequence":"additional","affiliation":[{"name":"Department of Medicine , Columbia University Irving Medical Center , Vagelos College of Physicians and Surgeons , New York , NY , USA"},{"name":"Center for Patient Safety Science , Columbia University , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5629-8892","authenticated-orcid":false,"given":"Eileen","family":"Carter","sequence":"additional","affiliation":[{"name":"School of Nursing , University of Connecticut , Storrs , CT , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Weill Cornell Medicine , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie R.","family":"Forman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Children\u2019s Hospital at Montefiore, Albert Einstein College of Medicine , Bronx , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8169-7118","authenticated-orcid":false,"given":"Michelle","family":"Gontasz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Gilmore","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9004-7149","authenticated-orcid":false,"given":"Hojjat","family":"Salmasian","sequence":"additional","affiliation":[{"name":"Department of Medicine , Brigham and Women\u2019s Hospital , Boston , MA , USA"},{"name":"Department of Biomedical and Health Informatics , Children\u2019s Hospital of Philadelphia , Philadelphia , PA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmina","family":"Erdei","sequence":"additional","affiliation":[{"name":"Department of Pediatrics , Brigham and Women\u2019s Hospital , Boston , MA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6851-4417","authenticated-orcid":false,"given":"Anika S.","family":"Naidu","sequence":"additional","affiliation":[{"name":"Center for Patient Safety Science , Columbia University , New York , NY , USA"},{"name":"Vagelos College of Physicians and Surgeons , Columbia University , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma J.","family":"Weatherford","sequence":"additional","affiliation":[{"name":"Center for Patient Safety Science , Columbia University , New York , NY , USA"},{"name":"Vagelos College of Physicians and Surgeons , Columbia University , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9565-6939","authenticated-orcid":false,"given":"Benjamin L.","family":"Ranard","sequence":"additional","affiliation":[{"name":"Department of Medicine , Columbia University Irving Medical Center , Vagelos College of Physicians and Surgeons , New York , NY , USA"},{"name":"Center for Patient Safety Science , Columbia University , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I-Fong Sun","family":"Lehman","sequence":"additional","affiliation":[{"name":"Department of Medicine , Columbia University Irving Medical Center , Vagelos College of Physicians and Surgeons , New York , NY , USA"},{"name":"Center for Patient Safety Science , Columbia University , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5083-4295","authenticated-orcid":false,"given":"Allen R.","family":"Chen","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine , Baltimore , MD , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dena","family":"Goffman","sequence":"additional","affiliation":[{"name":"Department of Quality and Patient Safety , NewYork-Presbyterian Hospital , New York , NY , USA"},{"name":"Department of Obstetrics & Gynecology , Columbia University Irving Medical Center , New York , NY , USA"},{"name":"Sloane Hospital for Women, NewYork-Presbyterian Hospital , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Babineau","sequence":"additional","affiliation":[{"name":"Department of Pediatric Emergency Medicine , Columbia University Irving Medical Center , New York , NY , USA"},{"name":"NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8094-4268","authenticated-orcid":false,"given":"Sandhya","family":"Brachio","sequence":"additional","affiliation":[{"name":"NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital , New York , NY , USA"},{"name":"Department of Pediatrics , Columbia University Irving Medical Center , New York , NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026091012590233380_j_jpm-2026-0027_ref_001","doi-asserted-by":"crossref","unstructured":"Krzyzaniak, N, 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Clin Pediatr Phila 2017;56:1157\u20139. https:\/\/doi.org\/10.1177\/0009922817701178.","DOI":"10.1177\/0009922817701178"},{"key":"2026091012590233380_j_jpm-2026-0027_ref_016","doi-asserted-by":"crossref","unstructured":"Besagar, S, Robles, PLA, Manzano, W, Applebaum, JR, Goffman, D, Adelman, JS. A national survey on the use of temporary naming conventions for newborns: 5-year Follow-up. Clin Pediatr Phila 2020;59:925\u20138. https:\/\/doi.org\/10.1177\/0009922820922534.","DOI":"10.1177\/0009922820922534"},{"key":"2026091012590233380_j_jpm-2026-0027_ref_017","unstructured":"Joint Commission International. Goals, standards, intents, and measureable elements: goal 1: identify patient correctly. Standard IPSG.01.00. In: Joint commission international accreditation standards for hospitals, 8th ed. [Internet]. 110. 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