How accurate is liquid medication administration?

We’ve been talking a lot these days about medication errors: wrong drug, wrong dose. We’re also talking about functional health literacy. Treatments we prescribe can get pretty complicated, and some folks just don’t have the skills to safely take care of themselves. So now we’re finding that, although some medication errors will always occur, they are more likely when functional health literacy is poor.

One area where the two meet is in the administration of liquid medication. Several variables contribute to this: identifying the right amount of liquid to get the right dose of medicine, and then measuring it accurately. One study of 302 parents (Yin, et al, 2010) set out to assess parents’ liquid medication administration errors by dosing instrument type. They also examined the degree to which parents’ health literacy influences dosing accuracy. They found that medication cups were associated with increased odds of making a dosing error (>20% deviation) as compared with the oral syringe. 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. Limited health literacy was associated with making a dosing error.

They concluded that dosing errors by parents were highly prevalent with cups compared with droppers, spoons, or syringes. They proposed that strategies to reduce errors should address both accurate use of dosing instruments and health literacy.

So where do you look first when a medication isn’t resulting in the health outcomes you expected? First make sure the drug was being administered. Then check the dose and frequency. Then you can reasonably question whether the specific medication choice or dose prescribed is the issue. Research shows just handing a person a prescription does not mean the rest of the process occurs, and occurs correctly.

Source: Yin, H. S., Mendelsohn, A. L., Wolf, M. S., Parker, R. M., Fierman, A., van Schaick, L., et al. (2010). Parents’ medication administration errors: role of dosing instruments and health literacy. Arch Pediatr Adolesc Med, 164(2), 181-186.

If you want to learn more about liquid medicine administration, here are some related articles:

Bailey, S. C., Pandit, A. U., Yin, S., Federman, A., Davis, T. C., Parker, R. M., et al. (2009). Predictors of misunderstanding pediatric liquid medication instructions. Fam Med, 41(10), 715-721.

Peacock, G., Parnapy, S., Raynor, S., & Wetmore, S. (2010). Accuracy and precision of manufacturer-supplied liquid medication administration devices before and after patient education. J Am Pharm Assoc (2003), 50(1), 84-86.

Wansink, B., & van Ittersum, K. (2010). Spoons systematically bias dosing of liquid medicine. Ann Intern Med, 152(1), 66-67.