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Parents' Medication Administration ErrorsRole of Dosing Instruments and Health Literacy
H. Shonna Yin, MD, MS;
Alan L. Mendelsohn, MD;
Michael S. Wolf, PhD, MPH;
Ruth M. Parker, MD;
Arthur Fierman, MD;
Linda van Schaick, MSEd;
Isabel S. Bazan, BA;
Matthew D. Kline, MA;
Benard P. Dreyer, MD
Arch Pediatr Adolesc Med. 2010;164(2):181-186.
Objectives To assess parents' liquid medication administration errors by dosing instrument type and to examine the degree to which parents' health literacy influences dosing accuracy.
Design Experimental study.
Setting Interviews conducted in a public hospital pediatric clinic in New York, New York, between October 28, 2008, and December 24, 2008.
Participants Three hundred two parents of children presenting for care were enrolled.
Main Outcome Measures Parents were observed for dosing accuracy (5-mL dose) using a set of standardized instruments (2 dosing cups [one with printed calibration markings, the other with etched markings], dropper, dosing spoon, and 2 oral syringes [one with and the other without a bottle adapter]).
Results The percentages of parents dosing accurately (within 20% of the recommended dose) were 30.5% using the cup with printed markings and 50.2% using the cup with etched markings, while more than 85% dosed accurately with the remaining instruments. Large dosing errors (>40% deviation) were made by 25.8% of parents using the cup with printed markings and 23.3% of parents using the cup with etched markings. In adjusted analyses, cups were associated with increased odds of making a dosing error (>20% deviation) compared with the oral syringe (cup with printed markings: adjusted odds ratio [AOR] = 26.7; 95% confidence interval [CI], 16.8-42.4; cup with etched markings: AOR = 11.0; 95% CI, 7.2-16.8). Compared with the oral syringe, cups were also associated with increased odds of making large dosing errors (cup with printed markings: AOR = 7.3; 95% CI, 4.1-13.2; cup with etched markings: AOR = 6.3; 95% CI, 3.5-11.2). Limited health literacy was associated with making a dosing error (AOR = 1.7; 95% CI, 1.1-2.8).
Conclusions Dosing errors by parents were highly prevalent with cups compared with droppers, spoons, or syringes. Strategies to reduce errors should address both accurate use of dosing instruments and health literacy.
Author Affiliations: Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York (Drs Yin, Mendelsohn, Fierman, and Dreyer, Mss van Schaick and Bazan, and Mr Kline); Institute for Healthcare Studies, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Dr Wolf); and Division of General Internal Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Parker).
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