Pictographic instructions, milliliter-only lab tools could help reduce errors
by Alexandria Bachert MPH, Staff Writer, MedPage Today June 27, 2017
• Parents often make measurement errors with their children’s medications, suggesting the need for tools to better match prescribed dose volumes in order to prevent accidental overdoses.
• Note that almost one third made at least one large error, but that when parents had dosing implements closely matched to prescribed dose volumes, the error rate was much lower.
Parents often make measurement errors with their children’s medications, suggesting the need for tools to better match prescribed dose volumes in order to prevent accidental overdoses, reported researchers.
According to results from a randomized trial involving nearly 500 parents, a large majority (83.5%) made at least one dosing error, reported H. Shonna Yin, MD, MS, of NYU Langone Medical Center, and colleagues in Pediatrics.
Almost one third made at least one large error, the researchers found. Among all errors, 12% involved an overdose.
But when parents had dosing implements closely matched to prescribed dose volumes, the error rate was much lower.
“Giving a parent a dosing tool, like an oral syringe, that is the right size, can have a big impact on whether a parents will dose a medication accurately,” Yin told MedPage Today.
“If the tool is too large, parents are more likely to overdose. If the tool is too small to allow the parent to measure the full dose with a single measurement, then parents will need to use math skills to figure out how to accurately measure more than one instrument-full, which increases the likelihood of a dosing error,” she explained.
Yin and colleagues recruited 491 parents from Feb. 20, 2015, to July 23, 2015 from three pediatrics outpatient clinics in New York City, Atlanta, and Atherton, Calif.
English- and Spanish-speaking parents with children ≤8 years old were randomly assigned to one of four groups:
• Text and pictogram instructions on the label, “mL”-only label and tool
• Text and pictogram instructions, “mL/tsp” label and tool
• Text-only instructions, “mL”-only label and tool
• Text-only instructions “mL/tsp” label and tool
Dosing error was determined by the weight of the measured dose compared with a reference weight (e.g., 5-mL dose defined as the average weight of 5 mL measured by 10 pediatricians using an oral syringe). If the measured amount was different from the amount listed on the label by >20%, the parent was considered to have made a clinically meaningful dosing error.
The researchers found that parents who received text and pictogram dosing instructions with “mL”-only labels and tools had decreased odds of making a dosing error compared with those who received “mL/tsp” labels and tools with or without pictographic dosing instructions.
There were more errors with the 2- and 7.5-mL doses tested compared with the 10-mL dose — 2 mL versus 10 mL: aOR 3.7 (95% CI 3.1–4.4) and 7.5 mL versus 10 mL: aOR 1.4 (95% 1.2–1.6).
For the 2-mL dose, the fewest errors were seen with the 5-mL syringe — 5- versus 10-mL syringe aOR: 0.3 (95% CI 0.2–0.4) and cup versus 10-mL syringe: aOR 7.5 (95% CI 5.7–10.0).
For the 7.5-mL dose, the fewest errors were with the 10-mL syringe — 5- versus 10-mL syringe: aOR 4.0 (95% CI 3.0–5.4) and cup versus 10-mL syringe: aOR 2.1 (95% CI 1.5–2.9).
Milliliter/teaspoon was linked to more errors than milliliter-only, aOR 1.3 (95% CI 1.05–1.6), noted the researchers.
“This study supports system-wide changes in the design of medication labels and provision of dosing tools that would help reduce medication errors in children,” Yin said in an interview.
She continued that the development of standards around the provision of dosing tools, by pharmacies and manufacturers of over-the-counter and prescription medications, along with increased awareness by providers and pharmacies, could help to better ensure that parents receive optimal dosing tools.
Looking forward, the researchers called for a comprehensive labeling and dosing strategy for pediatric liquid medications that they are now testing in a “real world” randomized trial.
Study limitations included the use of a hypothetical dosing scheme which might not have accurately reflected how parents dose at home, as well as a limited number of dosing tools, capacities, and volumes.