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Parents make fewer medication errors with oral syringes vs. dosing cups
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Pediatricians should encourage parents to use oral syringes instead of dosing cups, particularly for small doses, to avoid errors when they administer medicine to their children, according to recent study findings.
“Although considerable progress has been attained in making labeling improvements for adult medications, to date there has been limited work incorporating a pediatric perspective, despite studies documenting parent dosing error rates of 40% or more,” H. Shonna Yin, MD, MS, associate professor in the department of pediatrics at New York University School of Medicine, and colleagues wrote. “Lack of evidence regarding best practices has been a barrier to establishing standards related to the labeling and dosing of pediatric medications.”
Yin and colleagues conducted a multisite, randomized, controlled, 17-month experiment at three urban pediatric clinics to determine the extent to which parents made dosing errors due to mistakes on medication labels and dosing tools. They also examined if differences in health literacy and language created more errors. The study included 2,110 English- and Spanish-speaking parents with children aged 8 years and younger who were assigned to various study arms and given labels and dosing tools of different unit pairings.
Each parent measured nine doses [three amounts (2.5 mL, 5 mL and 7.5 mL) and three tools (one cup and two syringes measured in 0.2 mL and 0.5 mL increments)] of medication. Errors were considered dosages that deviated from the proper amount by more than 20%, and large errors were considered doses twice the correct amount.
Data showed that 84.4% of parents made one or more dosing errors, and 21% made one or more large errors during their nine trials. On average, parents made errors in 25.3% of trials, and overdosing occurred in 68% of these errors. Cups yielded more errors than syringes (adjusted OR = 4.6; 95% CI, 4.2-5.1), regardless of health literacy and language group (P < .001 for interaction), although a greater proportion of English-speaking parents showed more prominent differences with cup vs. syringe use. In addition, teaspoon-only labels correlated strongly with more errors compared with millimeter-only labels and tools (aOR = 1.2; 95% CI, 1.01-1.4).
“Use of dosing cups greatly increased the risk of errors, especially with smaller dose amounts,” the researchers wrote. “Although the strength of associations differed somewhat by health literacy and language, our study clearly identified certain improvements that could be made to labels and tools to enhance dosing accuracy for parents across groups.” – by Kate Sherrer
Disclosure: Yin reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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