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Yin HS, Parker RM, Sanders LM, Dreyer BP, Mendelsohn AL, Bailey S, Patel DA, Jimenez JJ, Kim KYA, Jacobson K, Hedlund L, Smith MCJ, Maness Harris L, McFadden T, Wolf MS. Liquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment. Pediatrics 2016; 138:peds.2016-0357. [PMID: 27621414 PMCID: PMC5051204 DOI: 10.1542/peds.2016-0357] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Poorly designed labels and packaging are key contributors to medication errors. To identify attributes of labels and dosing tools that could be improved, we examined the extent to which dosing error rates are affected by tool characteristics (ie, type, marking complexity) and discordance between units of measurement on labels and dosing tools; along with differences by health literacy and language. METHODS Randomized controlled experiment in 3 urban pediatric clinics. English- or Spanish-speaking parents (n = 2110) of children ≤8 years old were randomly assigned to 1 of 5 study arms and given labels and dosing tools that varied in unit pairings. Each parent measured 9 doses of medication (3 amounts [2.5, 5, and 7.5 mL] and 3 tools [1 cup, 2 syringes (0.2- and 0.5-mL increments)]), in random order. Outcome assessed was dosing error (>20% deviation; large error defined as > 2 times the dose). RESULTS A total of 84.4% of parents made ≥1 dosing error (21.0% ≥1 large error). More errors were seen with cups than syringes (adjusted odds ratio = 4.6; 95% confidence interval, 4.2-5.1) across health literacy and language groups (P < .001 for interactions), especially for smaller doses. No differences in error rates were seen between the 2 syringe types. Use of a teaspoon-only label (with a milliliter and teaspoon tool) was associated with more errors than when milliliter-only labels and tools were used (adjusted odds ratio = 1.2; 95% confidence interval, 1.01-1.4). CONCLUSIONS Recommending oral syringes over cups, particularly for smaller doses, should be part of a comprehensive pediatric labeling and dosing strategy to reduce medication errors.
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Affiliation(s)
- H. Shonna Yin
- Department of Pediatrics, NYU School of Medicine–Bellevue Hospital, New York, New York;,Department of Population Health, NYU School of Medicine, New York, New York
| | | | - Lee M. Sanders
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Benard P. Dreyer
- Department of Pediatrics, NYU School of Medicine–Bellevue Hospital, New York, New York
| | - Alan L. Mendelsohn
- Department of Pediatrics, NYU School of Medicine–Bellevue Hospital, New York, New York
| | - Stacy Bailey
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | | | - Jessica J. Jimenez
- Department of Pediatrics, NYU School of Medicine–Bellevue Hospital, New York, New York
| | - Kwang-Youn A. Kim
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Laurie Hedlund
- Division of General Internal Medicine and Geriatrics, and
| | - Michelle C. J. Smith
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Leslie Maness Harris
- Department of Pediatrics, NYU School of Medicine–Bellevue Hospital, New York, New York
| | - Terri McFadden
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
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Abstract
Medication errors may occur during parental administration of prescription and over-the-counter medications in the outpatient pediatric setting. Misinterpretation of medication labels and dosing errors are two types of errors in medication administration. Health literacy may play an important role in parents' ability to safely manage their child's medication regimen. There are several proposed strategies for decreasing these medication administration errors, including using standardized dosing instruments, using strictly metric units for medication dosing, and providing parents and caregivers with picture-based dosing instructions. Pediatric healthcare providers should be aware of these strategies and seek to implement many of them into their practices.
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Capino AC, Miller JL, Hughes KM, Miller MJ, Johnson PN. Caregiver Perception, Self-efficacy, and Knowledge of Methadone Tapers for Children With Iatrogenic Opioid Abstinence Syndrome. J Pharm Technol 2016; 32:104-115. [PMID: 34860963 PMCID: PMC5998460 DOI: 10.1177/8755122515622030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023] Open
Abstract
Background: There are no definitive guidelines regarding the management of iatrogenic opioid abstinence syndrome (IOAS), but methadone tapers are one common approach. Methadone tapers can be complex for caregivers to manage, and there is a paucity of data about caregiver experiences administering medication tapers postdischarge. Objective: The primary objective was to describe caregiver perception, self-efficacy, and knowledge of administering methadone tapers. Secondary objectives included an assessment of the change in self-efficacy and knowledge of methadone and IOAS before and after discharge as well as clinical outcomes occurring postdischarge. Methods: This was an exploratory, descriptive, institutional review board-approved study surveying caregivers of children receiving methadone tapers for IOAS. Caregivers were included if they had a child ≤12 years of age discharged to home on a methadone taper. The study consisted of 2 phases: a questionnaire and observation/counseling session predischarge and a telephone interview after taper completion. Univariate descriptive statistics were utilized for data analysis. Results: Phase 1 of the study was completed by 12 caregivers, and only 5 completed phase 2. The majority of caregivers were completely confident predischarge (83.3%) and postdischarge (80%) in administering methadone as prescribed. However, some caregivers were confused about the purpose of the taper and experienced difficulty in measuring oral solutions. Conclusions: Despite high self-efficacy, caregivers experienced difficulties in understanding taper management and during the observation session. The results of this study suggest presenting information to caregivers utilizing minimal medical jargon, conducting a counseling/observation session predischarge, and utilizing the teach-back method with caregivers to assess for understanding.
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Affiliation(s)
- Amanda C. Capino
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Jamie L. Miller
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
| | - Kaitlin M. Hughes
- University of Michigan C. S. Mott Children’s Hospital, Ann Arbor, MI, USA
| | | | - Peter N. Johnson
- University of Oklahoma College of Pharmacy, Oklahoma City, OK, USA
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Urban M, Leššo R, Pelclová D. Unintentional Pharmaceutical-Related Medication Errors Caused by Laypersons Reported to the Toxicological Information Centre in the Czech Republic. Basic Clin Pharmacol Toxicol 2016; 119:115-9. [DOI: 10.1111/bcpt.12578] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 12/23/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Michal Urban
- Toxicological Information Centre; Department of Occupational Medicine; 1st Medical Faculty; Charles University and General University Hospital; Prague Czech Republic
| | - Roman Leššo
- Toxicological Information Centre; Department of Occupational Medicine; 1st Medical Faculty; Charles University and General University Hospital; Prague Czech Republic
| | - Daniela Pelclová
- Toxicological Information Centre; Department of Occupational Medicine; 1st Medical Faculty; Charles University and General University Hospital; Prague Czech Republic
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Rak EC, Hooper SR, Belsante MJ, Burnett O, Layton B, Tauer D, Mantoo B, DeWalt D, Ferris ME. Caregiver word reading literacy and health outcomes among children treated in a pediatric nephrology practice. Clin Kidney J 2016; 9:510-5. [PMID: 27274841 PMCID: PMC4886911 DOI: 10.1093/ckj/sfw015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 02/19/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Caregivers play a major role in the healthcare of pediatric patients, particularly during childhood and adolescence. This study examined the impact of caregivers' functional literacy on the health outcomes of adolescents with chronic kidney disease (CKD) or end-stage kidney disease (ESKD). METHODS Caregiver-child dyads in a Southeastern US pediatric nephrology clinic participated in this cross-sectional study. We collected demographic information, data on caregivers' functional literacy skills (Wechsler Individual Achievement Test Word Reading Subtest) and child health outcomes (healthcare utilization and adherence). Negative binomial regression analyses were used to test the relationships. RESULTS A total of 98 pediatric patients and their caregivers participated. Caregivers' word reading literacy was associated with their children's healthcare utilization. Patients whose caregivers had lower word reading literacy skills (<7th grade) had greater incidence of emergency room (ER) visits (adjusted incidence rate ratio = 2.05, 95% confidence interval: 1.007, 4.177, P < 0.05) after adjusting for major demographic factors. Patients' hospitalization rates and adherence to medication/diet/appointments were comparable in the two groups. CONCLUSIONS Low caregiver functional word reading literacy was negatively related to health outcomes of adolescents with CKD/ESKD as reflected by greater ER visits. Educational materials and teaching strategies (dialysis training protocols, patient education materials) adjusted for low literacy levels may contribute to better outcomes.
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Affiliation(s)
- Eniko C Rak
- The University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
| | - Stephen R Hooper
- The University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
| | - Michael J Belsante
- The University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
| | - Otis Burnett
- The University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
| | - Bradley Layton
- Gillings School of Global Public Health, The University of North Carolina at Chapel Hill , Chapel Hill, NC , USA
| | | | | | - Darren DeWalt
- The University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
| | - Maria E Ferris
- The University of North Carolina at Chapel Hill School of Medicine , Chapel Hill, NC , USA
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Berthe-Aucejo A, Girard D, Lorrot M, Bellettre X, Faye A, Mercier JC, Brion F, Bourdon O, Prot-Labarthe S. Evaluation of frequency of paediatric oral liquid medication dosing errors by caregivers: amoxicillin and josamycin. Arch Dis Child 2016; 101:359-64. [PMID: 26729746 DOI: 10.1136/archdischild-2015-309426] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 12/01/2015] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study reconstitution and preparation dosing errors of liquid oral medications given by caregivers to children. METHODS A prospective observational study was carried out in the departments of general paediatrics and emergency paediatrics at the Robert-Debré Children's University Hospital. An interview with caregivers involved (1) practical reconstitution and preparation of an oral liquid medication from a prescription drawn at random (amoxicillin (Clamoxyl, dosing spoon) or josamycin (Josacine, dose-weight pipette)) and (2) a questionnaire about their use. RESULTS One hundred caregivers were included. Clamoxyl and Josacine were incorrectly reconstituted in 46% (23/50) and 56% (28/50) of cases, respectively, with a risk of underdosing of Clamoxyl (16/23) and overdosing of Josacine (23/28). Dose preparation with the dosing spoon was incorrect in 56% of cases, and in 10% of cases with the dose-weight pipette. Female sex, native French speaker, and age were significantly associated with correct reconstitution. Male sex and medication were significantly associated with correct preparation. CONCLUSIONS This study highlights the high incidence of errors made by caregivers in reconstituting and preparing doses of these liquid oral medicines, which are associated with considerable risks of over- and underdosing. Factors associated with these errors have been identified which could help health professionals to optimise their strategy for educating families about the use of liquid oral medications and the need to check that they understand these instructions.
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Affiliation(s)
| | - D Girard
- Unité d'Epidémiologie Clinique, AP-HP Hôpital Robert-Debré, Paris, France Pediatric Pulmonology Research Group, University Children's Hospital, Basel, Switzerland
| | - M Lorrot
- Service de pédiatrie Générale, AP-HP Hôpital Robert-Debré, Paris, France Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - X Bellettre
- Service d'Accueil des Urgences Pédiatriques, AP-HP Hôpital Robert-Debré, Paris, France
| | - A Faye
- Service de pédiatrie Générale, AP-HP Hôpital Robert-Debré, Paris, France Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - J C Mercier
- Université Paris 7 Denis Diderot, Sorbonne Paris Cité, Paris, France Service d'Accueil des Urgences Pédiatriques, AP-HP Hôpital Robert-Debré, Paris, France
| | - F Brion
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France Pharmacie clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - O Bourdon
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France Pharmacie clinique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Laboratoire Educations et Pratiques de Santé, EA 3412, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - S Prot-Labarthe
- Pharmacie, Hôpital Robert-Debré, APHP, Paris, France INSERM, U1123, ECEVE, Paris, France
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57
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Gildon BL, Condren M, Phillips C, Votruba A, Swar S. Appropriateness of oral medication delivery devices available in community pharmacies. J Am Pharm Assoc (2003) 2016; 56:137-40.e1. [DOI: 10.1016/j.japh.2016.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2015] [Indexed: 11/29/2022]
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Yin HS, Parker RM, Sanders LM, Dreyer BP, Mendelsohn A, Bailey S, Patel DA, Jimenez JJ, Kim KYA, Jacobson K, Hedlund L, Landa R, Maness L, Raythatha PT, McFadden T, Wolf MS. Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment. Acad Pediatr 2016; 16:734-741. [PMID: 27155289 PMCID: PMC5077678 DOI: 10.1016/j.acap.2016.04.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/24/2016] [Accepted: 04/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Some experts recommend eliminating "teaspoon" and "tablespoon" terms from pediatric medication dosing instructions, because these terms could inadvertently encourage use of nonstandard tools (ie, kitchen spoons), which are associated with dosing errors. We examined whether use of "teaspoon" or "tsp" on prescription labels affects parents' choice of dosing tools, and the role of health literacy and language. METHODS Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids [Safe Administration For Every Prescription for Kids] study), which randomized English- and Spanish-speaking parents (n = 2110) of children 8 years of age and younger to 1 of 5 groups, which varied in unit of measurement pairings on medication labels and dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy was measured using the Newest Vital Sign. RESULTS Seventy-seven percent had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either "tsp" or "teaspoon" units (alone or with "mL") chose nonstandard dosing tools (ie, kitchen teaspoon, kitchen tablespoon), compared with 8.3% who viewed "mL"-only labels (adjusted odds ratio [AOR] = 4.4 [95% confidence interval (CI), 3.3-5.8]). Odds varied based on whether "teaspoon" was spelled out or abbreviated ("teaspoon"-alone: AOR = 5.3 [95% CI, 3.8-7.3]); "teaspoon" with mL: AOR = 4.7 [95% CI, 3.3-6.5]; "tsp" with mL: AOR = 3.3 [95% CI, 2.4-4.7]; P < .001). Similar findings were noted across health literacy and language groups. CONCLUSIONS Use of teaspoon units ("teaspoon" or "tsp") on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies might be helpful to examine the real-world effect of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications.
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Affiliation(s)
- H. Shonna Yin
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States,Population Health, NYU School of Medicine, 550 First Avenue, New York, NY, 10016, United States
| | - Ruth M. Parker
- Medicine, Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, 30322, United States
| | - Lee M. Sanders
- Pediatrics, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA, CA, 94305, United States
| | - Benard P. Dreyer
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Alan Mendelsohn
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Stacy Bailey
- Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, 2204 Kerr Hall, Chapel Hill, NC, 27599, United States
| | - Deesha A. Patel
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
| | - Jessica J. Jimenez
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Kwang-Youn A. Kim
- Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
| | - Kara Jacobson
- Rollins School of Public Health Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States
| | - Laurie Hedlund
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
| | - Rosa Landa
- Pediatrics, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA, CA, 94305, United States
| | - Leslie Maness
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Purvi Tailor Raythatha
- Pediatrics, NYU School of Medicine - Bellevue Hospital, 550 First Avenue, New York, NY, 10016, United States
| | - Terri McFadden
- Pediatrics, Emory University School of Medicine, 1518 Clifton Road, Atlanta, GA, USA, 30322
| | - Michael S. Wolf
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States
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Johnson A, Meyers R. Evaluation of Measuring Devices Packaged With Prescription Oral Liquid Medications. J Pediatr Pharmacol Ther 2016; 21:75-80. [PMID: 26997931 PMCID: PMC4778700 DOI: 10.5863/1551-6776-21.1.75] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The US Food and Drug Administration industry guidelines for manufacturers of oral, over-the-counter, liquid medications recommend that these products be packaged with dosage-delivery devices. This study describes the prevalence of these devices and instructions packaged with prescription, oral, liquid medications. METHODS This was a descriptive study of prescription oral-liquid medications dispensed during a 6-month period at a community pharmacy. Product information was obtained from the National Library of Medicine's DailyMed database and from the products themselves. Endpoints included provision of a measuring device, the type of device, the maximum dose measurable and intervals on the provided device, and inclusion of instructions to the pharmacist. RESULTS A total of 382 liquid prescription medications were included in the study. Forty-nine of the 382 products (12.8%) were packaged with a measuring device. The most commonly provided device was a calibrated dropper (n = 18; 36.7%), followed by an oral syringe with a bottle adaptor (n = 9, 18.4%). Specific instructions on proper use of the provided measuring device were included with 20 products (40.8%). Among the products that did not provide a measuring device, only 70 of the 333 package inserts (21%) included instructions to the pharmacist regarding counseling the patient on proper administration. CONCLUSIONS Packaging of prescription oral-liquid medications is inconsistent and leaves room for vast variability in patient or parent administration practices. In the future, patterns of actual dispensing practices among pharmacies and pharmacists would help determine the true incidence of dispensing of measuring devices.
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Affiliation(s)
- Anthony Johnson
- Department of Pharmacy, Naval Medical Center, San Diego, California
| | - Rachel Meyers
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, New Jersey
- Department of Pharmacy, Saint Barnabas Medical Center, Livingston, New Jersey
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Bailey SC, Navaratnam P, Black H, Russell AL, Wolf MS. Advancing Best Practices for Prescription Drug Labeling. Ann Pharmacother 2015; 49:1222-36. [DOI: 10.1177/1060028015602272] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: Problematic prescription drug labeling has been cited as a root cause of patient misunderstanding, medication errors, and nonadherence. Although numerous studies have recently been conducted to identify and test labeling best practices, the last systematic review on this topic was conducted a decade ago. The objective of this review was, therefore, to examine, summarize, and update best practices for conveying written prescription medication information and instructions to patients. Data Sources: English-language articles published from June 2005 to June 2015 were identified in MEDLINE and CINAHL by searching the following text words: ‘ medication OR prescription OR drug’ AND ‘label OR leaflet OR brochure OR pamphlet OR medication guide OR medication insert OR drug insert OR medication information OR drug information OR instructions’ AND ‘ patient OR consumer.’ Reference mining and secondary searches were also performed. Study Selection and Data Extraction: A total of 31 articles providing evidence on how to improve written, prescription drug labeling for patient use were selected. Two reviewers independently screened articles, rated their quality, and abstracted data. Data Synthesis: Identified best practices included the use of plain language, improved formatting and organization, and more explicit instructions to improve patient comprehension. The use of icons had conflicting findings, and few studies tested whether practices improved knowledge or behaviors with patients’ actual prescribed regimens. Conclusions: Future studies are needed to determine how specific modifications and improvements in drug labeling can enhance patient knowledge and behavior in actual use. Synthesizing best practices across all patient materials will create a more useful, coordinated system of prescription information.
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Affiliation(s)
- Stacy Cooper Bailey
- Eshelman School of Pharmacy at The University of North Carolina, Chapel Hill, NC, USA
| | | | | | - Allison L. Russell
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
| | - Michael S. Wolf
- Feinberg School of Medicine at Northwestern University, Chicago, IL, USA
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61
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Devices for oral and respiratory paediatric medicines: What do healthcare professionals think? Int J Pharm 2015; 492:304-15. [DOI: 10.1016/j.ijpharm.2015.05.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/07/2015] [Accepted: 05/14/2015] [Indexed: 11/16/2022]
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Almazrou S, Alsahly H, Alwattar H, Alturki L, Alamri M. Ability of Saudi mothers to appropriately and accurately use dosing devices to administer oral liquid medications to their children. DRUG HEALTHCARE AND PATIENT SAFETY 2014; 7:1-6. [PMID: 25565895 PMCID: PMC4278728 DOI: 10.2147/dhps.s72315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Most liquid medications are packaged with administration devices, which may be used inappropriately or inaccurately, and sometimes are not used at all. Because of the importance of their proper use for children's health, this study was designed to assess Saudi mothers' experiences with measuring cups, syringes, and droppers for oral liquid medications; to compare accuracy of dosing across these devices; and to determine the effects of mothers' education statuses and pharmacist counseling on dosing accuracy. METHODS This was a cross-sectional study in which mothers were observed as they used a set of commonly available dosing devices which are a dosing cup, syringe, and dropper. Interviews were conducted in the outpatient pharmacy waiting area in several tertiary hospitals and primary clinics in Riyadh, Saudi Arabia between March and April 2013. Saudi women who were mothers of children aged 12 years old or younger and who gave their consent were eligible. Caregivers other than mothers and subjects with vision problems or cognitive/physical disabilities were excluded. We gathered demographic information such as age, number of children, and education status. Subjects were asked if they had had counseling on how to use measuring devices and which device they preferred. Then, the mothers were required to demonstrate how to measure 5 mL of paracetamol (acetaminophen) syrup using a cup and a syringe and 1 mL of paracetamol syrup using a dropper. Dosing errors were evaluated visually as overdosing, underdosing, or no error (if the dose was accurate). The data were entered into Microsoft Excel and evaluated using Stata 11.1. Logistic regression was employed to determine relationships. RESULTS The results revealed that 58% of participants measured an accurate dose of paracetamol using the oral dosing syringe versus 50% of participants using the dropper and 51% using the dosing cup. In general, participants measured more than the intended dose with the dosing cup and less than the intended dose with the dropper. Furthermore, we found that dosing accuracy for each type of instrument was significantly influenced by the mothers' education status. Among the study participants, 77% had not had previous counseling on the use of liquid medication measuring devices. However, dosing errors were not affected by previous counseling. CONCLUSION Among mothers using measuring devices, the most accurate doses were found to be measured with the use of the oral syringe, whereas the most errors were made with the use of the dropper. Moreover, education status had a significant effect on dosing errors. The use of a pictographic diagram could improve the mothers' dosing abilities and, thus, reduce dosing errors.
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Affiliation(s)
- Saja Almazrou
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Hind Alsahly
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Huda Alwattar
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Lamya Alturki
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mona Alamri
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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