4 ways parents can help prevent medication errors in children

Parents should stick with more precise metric measuring devices such as syringes instead of teaspoons to give children the correct dose of medications, U.S. and Canadian experts say.

Unintentional medication overdoses are a preventable problem that sends 70,000 children to emergency departments each year in the U.S. alone. It’s also a common cause of hospitalizations among children up to four years old, according to the Ontario Medical Association.

On Monday, the American Academy of Pediatrics released a policy statement to address two common sources of preventable errors for liquid medications — which children treated as outpatients mostly receive:

• Incorrect dosing devices.
• Giving the wrong volume.

Dr. Ian Paul, a pediatrician and lead author of the statement, said the academy is calling for a simple, universal standard of metric doses in order to change how doctors write prescriptions, how pharmacists dispense liquid medications and dosing cups, and how manufacturers print labels on their products.

The preferred device to use is an oral syringe, said pharmacist Julie Greenall, director of projects and education at the Institute for Safe Medication Practices Canada in Toronto.

The spoons in your kitchen drawer are good for soup and cereal and not for medication.- Julie Greenall, Institute for Safe Medication Practices Canada

"The spoons in your kitchen drawer are good for soup and cereal and not for medication," Greenall said in agreeing with the U.S. academy's point.

Part of the problem with kitchen spoons is they aren’t precise to measure a child’s medication, Paul said.

Metric vs. Imperial

Caregivers could also misinterpret millilitres for teaspoons or confuse teaspoons and tablespoons.

People may be confused because they don’t understand imperial measurements, which they never learned, Greenall said.

"They don't have that context so they're not going to think, 'Well, this looks like too much volume.’ A volume in a syringe,10 millilitres, is not really that much liquid so it doesn't look like this would be too much medication for a baby."

The institute’s tips to consumers include:

• Whenever you receive a new prescription, ask why the medicine has been prescribed, what the correct dosage is, and how often to take it.
• If the medicine has been prescribed for your child, the dose may depend on the child's age and weight. Make sure the prescriber and the pharmacy filling the prescription knows your child's current age and weight.
• If the pharmacy dispenses a liquid medicine or you pick one up off the shelf, ask for an oral syringe to measure the dose accurately. Ask the pharmacist to tell you the dose that has been prescribed and then show you how much liquid will provide this dose. If any of the information you receive is different from what you expected, ask the pharmacist to check the prescription with you again.
• Ask the doctor and the pharmacist about any side-effects to watch for and when to contact a health-care provider for help. This information is especially important when you are giving medicine to babies and young children.

Greenall also thinks it’s important the U.S. academy is taking a position on moving to metric units in health care, which could help prevent confusion on both sides of the border.

In 2011, ISMP Canada issued an alert about oral syringes marked in both millilitres and teaspoons after it received a report about a baby who was prescribed 2 mL of liquid antibiotic but the caregiver mistakenly measured two teaspoons or 10 mL — five times the intended dose. The baby had vomiting and diarrhea for 24 hours.

The U.S. academy recommends devices for precise measurements should be distributed with medication.

In Canada, Greenall said some pharmacies may label prescriptions in both millilitres and teaspoons and many measuring devices show both, but it would be best if the standard was "mL" for prescribers, pharmacists and on devices, to avoid confusion.