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Teum L, Gokhman F, Park S, Budnitz DS, Aquilina JW, Kuffner EK. A Pilot Study Assessing Common Medication Organizers for Child-Resistant Features. AJPM FOCUS 2024; 3:100232. [PMID: 38832092 PMCID: PMC11145423 DOI: 10.1016/j.focus.2024.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Introduction Prescription and most over-the-counter medicines are required to have child-resistant packaging and/or labeled with instructions "Keep out of reach of children." Although medication organizers are not required to have such design features or instructions, these could help prevent unsupervised ingestions by children. Commonly purchased medication organizers were evaluated for child-resistant design features and instructions for safe use to prevent unsupervised ingestions. Methods The 29 best-selling medication organizers on Amazon.com were identified, and product identifiers, design characteristics, and safety characteristics were recorded using a standardized instrument. Results Of the 29 medication organizers, none claimed to be child resistant. Only 31% provided a specific warning that the organizer was not child resistant on the packaging; only 41% communicated "Keep out of reach of children." Most organizers (59%) provided neither a warning that the organizer was not child resistant nor instructions to store out of reach of children. The majority of organizers (79%) shared the following characteristics: plastic construction, rectangular shape, nonelectronic flip-top opening mechanisms, and 7-day usage. Conclusions Opportunities exist for manufacturers of medication organizers to improve child-resistant product design, provide information to help prevent unsupervised ingestions (directions to keep the device out of the reach of children), and help to reduce unsupervised ingestions.
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Affiliation(s)
- Lilai Teum
- Global Product Safety, Johnson & Johnson Consumer, Skillman, New Jersey
- Janssen Pharmaceuticals, Raritan, New Jersey
| | - Fallon Gokhman
- Global Product Safety, Johnson & Johnson Consumer, Skillman, New Jersey
- Bristol Myers Squibb, Princeton, New Jersey
| | - Sophia Park
- Global Product Safety, Johnson & Johnson Consumer, Skillman, New Jersey
- Genmab US, Plainsboro, New Jersey
| | - Daniel S. Budnitz
- Global Product Safety, Johnson & Johnson Consumer, Skillman, New Jersey
- Johnson & Johnson Consumer, Skillman, New Jersey
| | | | - Edwin K. Kuffner
- Global Product Safety, Johnson & Johnson Consumer, Skillman, New Jersey
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Levene R, Renny MH, Seyoum T, Lim S, Fox C, Su MK. Medical Toxicology Education in Pediatrics Residency Training: Can It Be Improved? J Pediatr 2024; 267:113473. [PMID: 37182661 DOI: 10.1016/j.jpeds.2023.113473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/23/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Rachel Levene
- Department of Emergency Medicine and Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Madeline H Renny
- Department of Emergency Medicine, Pediatrics and Population Health Science and Policy, Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Theodros Seyoum
- Division of Epidemiology, NYC Department of Health & Mental Hygiene, New York, NY
| | - Sungwoo Lim
- Division of Epidemiology, NYC Department of Health & Mental Hygiene, New York, NY
| | - Carolyn Fox
- Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, OR
| | - Mark K Su
- Medical Toxicology, New York City Poison Center, NYC Department of Health & Mental Hygiene, New York, NY; Department of Emergency Medicine, New York University School of Medicine, New York, NY
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Lovegrove MC, Weidle NJ, Geller AI, Lind JN, Rose KO, Goring SK, Budnitz DS. Trends in Emergency Department Visits for Unsupervised Pediatric Medication Exposures. Am J Prev Med 2023; 64:834-843. [PMID: 37210158 PMCID: PMC10935594 DOI: 10.1016/j.amepre.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 05/22/2023]
Abstract
INTRODUCTION Emergency department visits and hospitalizations for unsupervised medication exposures among young children increased in the early 2000s. Prevention efforts were initiated in response. METHODS Nationally representative data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project collected from 2009 to 2020 were analyzed in 2022 to assess overall and medication-specific trends in emergency department visits for unsupervised exposures among children aged ≤5 years. RESULTS From 2009 to 2020, there were an estimated 677,968 (95% CI=550,089, 805,846) emergency department visits for unsupervised medication exposures among children aged ≤5 years in the U.S. Most visits involved children aged 1-2 years (2009-2012 [70.3%], 2017-2020 [67.4%]), and nearly one half involved prescription solid medications (2009-2012 [49.4%], 2017-2020 [48.1%]). The largest declines in estimated numbers of annual visits from 2009-2012 to 2017-2020 were for exposures involving prescription solid benzodiazepines (-2,636 visits, -72.0%) and opioids (-2,596 visits, -53.6%) and over-the-counter liquid cough and cold medications (-1,954 visits, -71.6%) and acetaminophen (-1,418 visits, -53.4%). The estimated number of annual visits increased for exposures involving over-the-counter solid herbal/alternative remedies (+1,028 visits, +65.6%), with the largest increase for melatonin exposures (+1,440 visits, +421.1%). Overall, the estimated number of visits for unsupervised medication exposures decreased from 66,416 in 2009 to 36,564 in 2020 (annual percentage change= -6.0%). Emergent hospitalizations for unsupervised exposures also declined (annual percentage change= -4.5%). CONCLUSIONS Declines in estimated emergency department visits and hospitalizations for unsupervised medication exposures from 2009 to 2020 coincided with renewed prevention efforts. Targeted approaches may be needed to achieve continued declines in unsupervised medication exposures among young children.
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Affiliation(s)
- Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Nina J Weidle
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Eagle Global Scientific, LLC, Atlanta, Georgia
| | - Andrew I Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer N Lind
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kathleen O Rose
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Chenega Enterprise Systems and Solutions, Atlanta, Georgia
| | - Sandra K Goring
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Chenega Enterprise Systems and Solutions, Atlanta, Georgia
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Francis M, Spiller HA, Badeti J, Casavant MJ, Michaels NL, Zhu M, Smith GA. Antidepressant Exposures Associated with Exploratory Behavior Among Young Children Reported to United States Poison Control Centers, 2000-2020. Pharmacoepidemiol Drug Saf 2022; 31:1206-1216. [PMID: 35999648 DOI: 10.1002/pds.5534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 07/31/2022] [Accepted: 08/20/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE This study investigates characteristics and trends of antidepressant exposures among children <6 years old related to exploratory behavior reported to US poison control centers. METHODS Using data from the National Poison Data System for 2000-2020, population-based annual exposure rates by sex, antidepressant category, serious medical outcome, and health care facility admission were analyzed and odds ratios to assess associations of exposure type and antidepressant category with medical outcome and admission were calculated. RESULTS There were 215,909 first-ranked unintentional exploratory exposures involving antidepressants among children <6 years old during the study period, averaging 10,281 annually. Most cases were <3 years old (77.8%), involved a single substance (86.9%), and did not receive treatment at a health care facility (57.6%); however, 7.9% were admitted and 3.4% had serious medical outcomes, including 13 deaths. SSRIs were involved in 56.9% of all cases. Compared with SSRIs, bupropion (OR: 5.22, 95% CI: 4.68 - 5.82), TCAs (OR: 3.74, 95% CI: 3.44 - 4.07), SNRIs (OR: 2.39, 95% CI: 2.11 - 2.71), and lithium salts (OR: 2.00, 95% CI: 1.63 - 2.46) were more likely to be associated with a serious medical outcome. TCAs were the first-ranked substance in 7 of the 13 deaths. CONCLUSIONS Although most unintentional antidepressant exposures related to pediatric exploratory behavior were inconsequential, an important minority of cases required admission to a HCF or had a serious medical outcome, including 13 deaths. Therefore, increased efforts to prevent these exposures among young children are needed, including public education and improved medication packaging. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Matilda Francis
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,Eastern Virginia Medical School, Norfolk, VA
| | - Henry A Spiller
- The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH
| | - Jaahnavi Badeti
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH
| | - Marcel J Casavant
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH.,Central Ohio Poison Center at Nationwide Children's Hospital, Columbus, OH
| | - Nichole L Michaels
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH
| | - Motao Zhu
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH
| | - Gary A Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children's Hospital, Columbus, OH.,The Ohio State University College of Medicine, Department of Pediatrics, Columbus, OH.,Child Injury Prevention Alliance, Columbus, OH
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Cullen SM, Osorio SN, Abramson EA, Kyvelos E. Improving Caregiver Understanding of Liquid Acetaminophen Administration at Primary Care Visits. Pediatrics 2022; 150:188487. [PMID: 35909148 DOI: 10.1542/peds.2021-054807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Liquid medication dosing errors are common in pediatrics. Our outpatient clinic identified gaps in caregiver education based on a 2015 American Academy of Pediatrics policy statement on prescribing liquid medications. This quality improvement (QI) initiative sought to improve caregiver's understanding of liquid acetaminophen administration at the 2-month well-child visit from 30% to 70% over a 32-month period. METHODS A resident-led interdisciplinary QI team performed sequential interventions to improve our outcome measure: the percentage of caregivers with an adequate understanding of 4 essential components of liquid acetaminophen administration (name, indication, dose, and frequency). Outcome data were collected via a 4-item verbal assessment of caregiver's understanding by nursing staff, with correct answers to all items considered adequate understanding. Process measures (medications prescribed and education provided), and balancing measures (anticipatory guidance items discussed) were gathered via electronic health record review. Shewhart "P" charts and established rules for detecting special cause variation were used to analyze data. Scatter plots assessed the association between the provision of syringes and caregiver understanding of medication administration. RESULTS In 636 caregivers, overall understanding of medication use improved from 39.8% to 74%. Knowledge of accurate dosage improved from 50.9% to 76.8%. Correlation between syringe provision and caregiver understanding was strong (R = .84). CONCLUSIONS Resident-led QI improved caregiver's understanding of liquid acetaminophen administration in infants. The most impactful interventions were implementation of English and Spanish pictograms and provision of dose-demarcated oral syringes, coupled with teach-back. Future interventions will examine generalizability to other medications and expansion to other services.
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Affiliation(s)
| | | | - Erika A Abramson
- Departments of Pediatrics.,Population Health Sciences, Weill Cornell Medical Center and New York-Presbyterian Hospital, New York, New York
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Auger N, Chadi N, Low N, Ayoub A, Lo E, Luu TM. Maternal Substance Use Disorders and Accidental Drug Poisonings in Children. Am J Prev Med 2022; 62:360-366. [PMID: 34802817 DOI: 10.1016/j.amepre.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/07/2021] [Accepted: 09/09/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Risk factors for accidental drug poisonings in children are poorly understood, including the association with maternal substance use. This study seeks to determine whether maternal substance use disorders before birth are associated with the future risk of accidental drug poisonings in young children. METHODS This study was a longitudinal cohort analysis of 1,032,209 children aged <5 years between 2006 and 2020 in Quebec, Canada. The main exposure included maternal substance use disorders before or during pregnancy. The outcome was hospitalization for drug poisonings before age 5 years, including opioids, cannabis, sedatives/hypnotics, stimulants, and other drugs. Adjusted Cox proportional hazards regression was used to compute hazard ratios and 95% CIs for the association of substance use disorders with child drug poisonings during 4,523,003 person-years of follow-up. Analyses were conducted in 2020. RESULTS Hospitalization rates for drug poisoning before age 5 years were greater for children of mothers with substance use disorders versus no substance use disorder (84.8 vs 20.7 per 100,000 person-years). Maternal substance use disorders before birth were associated with 2.28 times the risk of future drug poisonings in children (95% CI=1.63, 3.20). The association was stronger for maternal opioid use disorders (hazard ratio=4.16, 95% CI=2.38, 7.27) than other drug use disorders. Associations with child poisonings were stronger between age 1 and 2 years (hazard ratio=3.26, 95% CI=2.09, 5.10) and for poisonings involving opioids, cannabis, and sedative/hypnotic drugs. CONCLUSIONS Maternal substance use disorders before childbirth may be markers of future risk of drug poisonings in young children.
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Affiliation(s)
- Nathalie Auger
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Aimina Ayoub
- Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada; Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Ernest Lo
- Bureau d'information et d'études en santé des populations, Institut national de santé publique du Québec, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine University Hospital Research Centre, University of Montreal, Montreal, Quebec, Canada
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Mital R, Lovegrove MC, Moro RN, Geller AI, Weidle NJ, Lind JN, Budnitz DS. US emergency department visits for acute harms from over-the-counter cough and cold medications, 2017-2019. Pharmacoepidemiol Drug Saf 2022; 31:225-234. [PMID: 34757641 PMCID: PMC10917081 DOI: 10.1002/pds.5384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/06/2021] [Accepted: 11/05/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE Characterization of emergency department (ED) visits for acute harms related to use of over-the-counter cough and cold medications (CCMs) by patient demographics, intent of CCM use, concurrent substance use, and clinical manifestations can help guide prevention of medication harms. METHODS Public health surveillance data from the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance project were used to estimate numbers and population rates of ED visits from 2017 to 2019. RESULTS Based on 1396 surveillance cases, there were an estimated 26 735 (95% CI, 21 679-31 791) US ED visits for CCM-related harms annually, accounting for 1.3% (95% CI, 1.2-1.5%) of all ED visits for medication adverse events. Three fifths (61.4%, 95% CI, 55.6-67.2%) of these visits were attributed to non-therapeutic CCM use (nonmedical use, self-harm, unsupervised pediatric exposures). Most visits by children aged <4 years (74.0%, 95% CI, 59.7-88.3%) were for unsupervised CCM exposures. Proportion hospitalized was higher for visits for self-harm (76.5%, 95% CI, 68.9-84.2%) than for visits for nonmedical use (30.3%, 95% CI, 21.1-39.6%) and therapeutic use (8.8%, 95% CI, 5.9-11.8%). Overall, estimated population rates of ED visits for CCM-related harms were higher for patients aged 12-34 years (16.5 per 100 000, 95% CI, 13.0-20.0) compared with patients aged <12 years (5.1 per 100 000, 95% CI, 3.6-6.5) and ≥ 35 years (4.3 per 100 000, 95% CI, 3.4-5.1). Concurrent use of other medications, illicit drugs, or alcohol was frequent in ED visits for nonmedical use (61.3%) and self-harm (75.9%). CONCLUSIONS Continued national surveillance of CCM-related harms can assess progress toward safer use.
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Affiliation(s)
- Rohan Mital
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Maribeth C Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Ruth N Moro
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Andrew I Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Nina J Weidle
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
- Eagle Global Scientific, LLC (contractor to CDC), Atlanta, Georgia, USA
| | - Jennifer N Lind
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Daniel S Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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Burns MM, Renny MH. Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications. Pediatrics 2021; 148:peds.2021-052189. [PMID: 34607933 DOI: 10.1542/peds.2021-052189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Michele M Burns
- Harvard Medical Toxicology Fellowship, Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Madeline H Renny
- Departments of Population Health, Emergency Medicine, and Pediatrics, Grossman School of Medicine, New York University, New York, New York
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Budnitz DS, Shehab N, Lovegrove MC, Geller AI, Lind JN, Pollock DA. US Emergency Department Visits Attributed to Medication Harms, 2017-2019. JAMA 2021; 326:1299-1309. [PMID: 34609453 PMCID: PMC8493432 DOI: 10.1001/jama.2021.13844] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Assessing the scope of acute medication harms to patients should include both therapeutic and nontherapeutic medication use. OBJECTIVE To describe the characteristics of emergency department (ED) visits for acute harms from both therapeutic and nontherapeutic medication use in the US. DESIGN, SETTING, AND PARTICIPANTS Active, nationally representative, public health surveillance based on patient visits to 60 EDs in the US participating in the National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance Project from 2017 through 2019. EXPOSURES Medications implicated in ED visits, with visits attributed to medication harms (adverse events) based on the clinicians' diagnoses and supporting data documented in the medical record. MAIN OUTCOMES AND MEASURES Nationally weighted estimates of ED visits and subsequent hospitalizations for medication harms. RESULTS Based on 96 925 cases (mean patient age, 49 years; 55% female), there were an estimated 6.1 (95% CI, 4.8-7.5) ED visits for medication harms per 1000 population annually and 38.6% (95% CI, 35.2%-41.9%) resulted in hospitalization. Population rates of ED visits for medication harms were higher for patients aged 65 years or older than for those younger than 65 years (12.1 vs 5.0 [95% CI, 7.4-16.8 vs 4.1-5.8] per 1000 population). Overall, an estimated 69.1% (95% CI, 63.6%-74.7%) of ED visits for medication harms involved therapeutic medication use, but among patients younger than 45 years, an estimated 52.5% (95% CI, 48.1%-56.8%) of visits for medication harms involved nontherapeutic use. The proportions of ED visits for medication harms involving therapeutic use were lowest for barbiturates (6.3%), benzodiazepines (11.1%), nonopioid analgesics (15.7%), and antihistamines (21.8%). By age group, the most frequent medication types and intents of use associated with ED visits for medication harms were therapeutic use of anticoagulants (4.5 [95% CI, 2.3-6.7] per 1000 population) and diabetes agents (1.8 [95% CI, 1.3-2.3] per 1000 population) for patients aged 65 years and older; therapeutic use of diabetes agents (0.8 [95% CI, 0.5-1.0] per 1000 population) for patients aged 45 to 64 years; nontherapeutic use of benzodiazepines (1.0 [95% CI, 0.7-1.3] per 1000 population) for patients aged 25 to 44 years; and unsupervised medication exposures (2.2 [95% CI, 1.8-2.7] per 1000 population) and therapeutic use of antibiotics (1.4 [95% CI, 1.0-1.8] per 1000 population) for children younger than 5 years. CONCLUSIONS AND RELEVANCE According to data from 60 nationally representative US emergency departments, visits attributed to medication harms in 2017-2019 were frequent, with variation in products and intent of use by age.
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Affiliation(s)
- Daniel S. Budnitz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nadine Shehab
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Lantana Consulting Group, Atlanta, Georgia
| | - Maribeth C. Lovegrove
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andrew I. Geller
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennifer N. Lind
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Daniel A. Pollock
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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NCPDP recommendations for standardizing dosing in metric units (mL) on prescription container labels of oral liquid medications, version 2.0. Am J Health Syst Pharm 2021; 78:578-605. [PMID: 33647100 PMCID: PMC7970405 DOI: 10.1093/ajhp/zxab023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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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