Parent Dosing Tool Use, Beliefs, and Access: A Health Literacy Perspective

Williams, Tiffany S.; Wolf, Michael S.; Parker, Ruth M.; Sanders, Lee; Bailey, Stacy Cooper; Mendelsohn, Alan L.; Dreyer, Benard P.; Velazquez, Jessica J.; Yin, H. Shonna

doi:10.1016/j.jpeds.2019.08.017

Cited by 15 publications

(21 citation statements)

References 35 publications

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“…Another study by Yin et al 16 found a significant association between health literacy and dosing errors using cups and dosing spoons. In adjusted analysis conducted by Williams et al , 27 they found that there was a strong association between health literacy levels and measurement tool preference in particular cups, parents with limited literacy reported that dosing cups were the tool of choice most of the time (aOR=2.4). The use of a teaspoon/tablespoon was associated with errors in the intended dose for those with low health literacy but not for those with adequate health literacy.…”

Section: Resultsmentioning

confidence: 98%

“…The details of the 14 studies are presented in (tables 1 and 2). [15][16][17][18][19][20][21][22][23][24][25][26][27][28] The majority of the included studies were published in the last 12 years. All of the studies (n=14) took place in the USA.…”

Section: Resultsmentioning

confidence: 99%

“… 21 24 In a cross-sectional study conducted in the USA, the majority 66% of the parents considered oral syringes are the best tool for dosing accuracy, while 23.5% believed that cups were the best; however, few 10.1% believed that dosing spoon, measuring spoon, kitchen teaspoon and droppers were the best. 27 Another study reported that larger dosing errors (>40% deviation of the recommended dose) were made by parents using cups with printed marking and etched markings; this was thought to be due to confusion about teaspoon versus tablespoon instructions, assumptions that the cup is the unit of measure and the full cup is the dose. 16 Labels and units of the prescribed medication were contributing factors to dosing errors.…”

Section: Resultsmentioning

confidence: 99%

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Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Dahmash

Shariff

Kirby

et al. 2020

bmjpo

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ObjectiveTo identify studies that highlighted medication administration problems experienced by parents and children, which also looked at health literacy aspect using a validated tool to assess for literacy.Study designTen electronic databases were systematically searched and supplemented by hand searching through reference lists using the following search terms: (1) paediatric, (2) medication error including dosing error, medication administration error, medication safety and medication optimisation and (3) health literacy.ResultsOf the (1230) records screened, 14 studies were eligible for inclusion. Three analytical themes emerged from the synthesis. The review highlighted that frequencies and magnitudes of dosing errors vary by the measurement tools used, the dose prescribed and by the administration instruction provided. Parent’s sociodemographic, such as health literacy and language, is a key factor to be considered when designing an intervention aimed at averting medication administration errors at home. The review summarised some potential strategies that could help in reducing medication administration errors among children at home. Among these recommendations is to show the prescribed dose to the parents or young people along with the verbal instructions, as well as to match the prescribed dose with the measuring tool dispensed, to provide an explicit dose intervals and pictographic dosing instructions.ConclusionThe findings suggest that in order to optimise medication use by parents, further work is needed to address the nature of these issues at home. Counselling, medication administration instructions and measurement tools are some of the areas in addition to the sociodemographic characteristics of parents and young people that need to be considered when designing any future potential intervention aimed at reducing medication errors among children and young people at home.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Dahmash

Shariff

Kirby

et al. 2020

bmjpo

View full text Add to dashboard Cite

show abstract

“…Household teaspoons and tablespoons have proven to be inaccurate and error-prone when used by patients and caregivers as medication measuring tools since volumes in these household devices are not standardized. 21-22 , 27 , 38 - 39 , 75 - 76 , 87 Although some kitchen cooking and measuring sets include a volumetric measure along with the household measure, these too cannot be relied on to provide accurate dosing, and calibrated oral dosing devices were preferred even when teaspoon was recognized. 74 , 75…”

Section: 3 Recommendationmentioning

confidence: 99%

“… 40 Dispensing dosing devices with numeric graduations and units (mL) that correspond with the container labeling can reinforce use of a calibrated dosing device rather than household spoons or kitchen utensils. 28-29 , 48 , 74 , 75 , 87 …”

Section: 3 Recommendationmentioning

confidence: 99%

NCPDP recommendations for standardizing dosing in metric units (mL) on prescription container labels of oral liquid medications, version 2.0

2021

American Journal of Health-System Pharmacy

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Purpose Best practices and guidance are provided for standardizing dosing instructions on prescription container labels of oral liquid medications by eliminating use of U.S. customary (household) units and adopting metric units universally, with the goal of decreasing the potential for error and improving safety and outcomes when patients and caregivers take and administer these medications. Summary Despite decades of best practice use of metric units in organized healthcare settings and advocacy by various professional societies, medication safety experts, and standards setting organizations, use of household units (e.g., teaspoon) on prescription container labeling instructions for oral liquid medications persists in community pharmacy settings. Five years after publication of the National Council for Prescription Drug Programs’ (NCPDP’s) original white paper advocating metric-only dosing, very few community pharmacy companies appear to require oral liquid dosing instructions be presented in metric-only units (mL). Error-prone dosing designations contribute to medication errors and patient harm. Use of both multiple volumetric units (e.g., teaspoonsful, tablespoonsful) and multiple abbreviations for the same volumetric units (e.g., mL, cc, mls; tsp, TSP, t) increases the likelihood of dosing errors. Opportunities for error exist with each administration of an oral liquid medication and, unless coordinated with dispensing of appropriate oral dosing devices and optimal counseling, can result in use of household utensils (e.g., uncalibrated teaspoons) or discordantly marked devices that can further exacerbate the risk of error. Since publication of NCPDP’s original white paper, new standards have been adopted governing official liquid volume representation, calibrated dosing devices, and e-prescribing software which support the elimination of non-metric units to reduce use of dosing practices that are error-prone. In each case, U.S. customary (household) units have been eliminated in official standards and certification requirements. Therefore, use of non-metric units for oral dosing of liquid medications no longer is an acceptable practice. Conclusion Key factors contributing to dosing errors with oral liquid medications include use of multiple volumetric units and abbreviations; failure to institute policies and procedures that eliminate the use of non-metric (e.g., household) units and universally adopt metric-only dosing instructions in all settings; failure to coordinate dosing instructions with dosing device markings, appropriate type (oral syringe versus cup), and optimal volumes (e.g., 1-, 5-, or 10-mL devices); failure to adequately counsel patients about appropriate measurement and administration of oral liquid medication doses; and use or error-prone practices such as missing leading zeros and elimination of trailing zeros in prescriptions and container labels. Adoption of this white paper’s recommendations will align dosing designations for oral liquid medications in all settings with current standards and attain universal metric-only practice.

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Complexity of Medication Regimens for Children With Neurological Impairment

et al. 2021

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IMPORTANCE Parents of children with severe neurological impairment (SNI) manage complex medication regimens (CMRs) at home, and clinicians can help support parents and simplify CMRs.OBJECTIVE To measure the complexity and potentially modifiable aspects of CMRs using the Medication Regimen Complexity Index (MRCI) and to examine the association between MRCI scores and subsequent acute visits. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study was conducted between April 1, 2019, and December 31, 2020, at a single-center, large, hospital-based, complex care clinic.Participants were children with SNI aged 1 to 18 years and 5 or more prescribed medications. EXPOSURE Home medication regimen complexity was assessed using MRCI scores. The total MRCI score is composed of 3 subscores (dosage form, dose frequency, and specialized instructions). MAIN OUTCOMES AND MEASURESPatient-level counts of subscore characteristics and additional safety variables (total doses per day, high-alert medications, and potential drug-drug interactions) were analyzed by MRCI score groups (low, medium, and high score tertiles). Associations between MRCI score groups and acute visits were tested using Poisson regression, adjusted for age, complex chronic conditions, and recent health care use. RESULTSOf 123 patients, 73 (59.3%) were male with a median (interquartile range [IQR]) age of 9 (5-13) years. The median (IQR) MRCI scores were 46 (35-61 [range, 8-139]) overall, 29 (24-35) for the low MRCI group, 46 (42-50) for the medium MRCI group, and 69 (61-78) for the high MRCI group.The median (IQR) counts for the subscores were 6 (4-7) dosage forms per patient, 7 (5-9) dose frequencies per patient, and 5 (4-8) instructions per patient, with counts increasing significantly across higher MRCI groups. Similar trends occurred for total daily doses (median [IQR],[31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] doses), high-alert medications (median [IQR], 3 [1-5] medications), and potential drug-drug interactions (median [IQR], 3 [0-6] interactions). Incidence rate ratios of 30-day acute visits were 1.26 times greater (95% CI, 0.57-2.78) in the medium MRCI group vs the low MRCI group and 2.42 times greater (95% CI, 1.10-5.35) in the high MRCI group vs the low MRCI group. CONCLUSIONS AND RELEVANCEHigher MRCI scores were associated with multiple dose frequencies, complicated by different dosage forms and instructions, and associated with subsequent acute visits. These findings suggest that clinical interventions to manage CMRs could target various aspects of these regimens, such as the simplification of dosing schedules.

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Parent Dosing Tool Use, Beliefs, and Access: A Health Literacy Perspective

Cited by 15 publications

References 35 publications

Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

Literature review of medication administration problems in paediatrics by parent/caregiver and the role of health literacy

NCPDP recommendations for standardizing dosing in metric units (mL) on prescription container labels of oral liquid medications, version 2.0

Complexity of Medication Regimens for Children With Neurological Impairment

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