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Twenty percent of parents who participated in a randomized controlled trial measured twice the recommended dose of liquid medications according to an article published in Pediatrics last week. The study also revealed that almost all of the parents incorrectly measured liquid medications to some degree.
Dosing cups appeared to increase the risk of error more than using a syringe. Measurement labels also played a role in the rate of error with teaspoon labels being more problematic than milliliters.
The study’s findings point to the need to change the labeling and dosing tools used by parents to administer liquid medications to their children. The study’s author H. Shonna Yin, MD and colleagues, from the department of pediatrics at New York University School of Medicine–Bellevue Hospital say that providing parents with an oral syringe instead of the traditional dosing cup can be particularly helpful especially for medications that are administered in small doses.
This new recommendation goes one step beyond the American Academy of Pediatrics policy change last year that advocates milliliter-exclusive dosing.
The study’s authors say medication labels alone aren’t enough to decrease the rate of inadequate dosing. The dosing tool is equally important.
"Specifically, we examined the extent to which rates of parent dosing errors are affected by discordance in unit pairing on the label and tool and by dosing tool characteristics," the authors explain. "We hypothesized that unit concordance would be associated with fewer errors and that parents would measure most accurately with syringes."
A group of 2,110 parents with children younger than the age of 9 were randomly selected to test the researchers’ hypothesis.
Each parent was given several bottle labels and dosing tools and asked to measure three different doses (2.5 mL, 5 mL, and 7.5 mL) using three different dosing tools (10-mL syringes with 0.2-mL markings, 10-mL syringes with 0.5-mL markings, and a 30-mL capacity dosing cup). In total, they measured 9 doses, 3 per dosing tool.
Twenty-one percent of parents made a large dosing error, which was defined as measuring more than twice the directed dose. Nearly all, or 99.3 percent measured at least one dose that was not the exact amount directed on the label.
Of the errors, 68 percent were overdoses. The most errors were recorded with 2.5- and 7.5-mL dose amounts compared to 5-mL dose amounts.
The differences in error rates between cups and syringes were greatest for 2.5- and 5-mL doses, suggesting that "it may be beneficial to recommend the use of different tool types depending on the dose amount," the authors write. "Our findings indicate that particularly when smaller doses are prescribed, providers may want to encourage parent use of syringes by providing them with a syringe to take home; cups may be acceptable for larger doses."
For more information, read the entire study here.