medication errors

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Lose The Spoon: Study Finds Milliliters Best For Measuring Kids' Meds

Spoon with liquid medication (Wikimedia Commons)

Spoon with liquid medication (Wikimedia Commons)

Veronica Thomas
CommonHealth Intern

You wake up to your 8-year-old son crying in the middle of the night. He’s had a sore throat for a few days, which the pediatrician is treating with liquid Tylenol. As you grab the bottle and kitchen spoon from the medicine cabinet, you wrack your brain trying to remember the doctor’s instructions. Was it two teaspoons or two tablespoons? But wait, the pharmacist had said to measure it in milliliters.

Confusion about medication measurement like this is surprisingly common among parents, often resulting in serious dosing errors that contribute to more than 10,000 calls to poison centers each year and 70,000 ER visits.

Parents who used teaspoons or tablespoons were twice as likely to make a mistake.

A new study in the journal Pediatrics found that around 39 percent of parents incorrectly measured the dose they intended and about 41 percent made an error in measuring what their doctor had prescribed. The researchers found that parents who used teaspoon or tablespoon units for medications were twice as likely to make a mistake in measuring the dose compared to parents who only measured medications in milliliters.

This increased error may partly be due to the fact that parents measuring in teaspoons or tablespoons are more likely to use a kitchen spoon to measure the medication, rather than a standardized instrument like an oral syringe or cup. However, even parents using standardized instruments were more likely to make a dosing mistake if they used teaspoon or tablespoon units. The link between tablespoon or teaspoon use and measurement error was even stronger among parents with low health literacy or limited English proficiency.

To minimize this confusion and reduce medication errors among parents, the study investigators suggest adopting a milliliter-only unit of measurement. But while a standardized unit of measure seems like the logical fix, it probably won’t be a quick one, according to Dr. Shonna Yin, the lead investigator of the study.

She sees growing support for a move towards a standard milliliter system from groups like the American Academy of Pediatrics, the American Academy of Family Physicians and the American Association of Poison Control Centers, but says concerns remain that this transition would cause greater confusion, since parents are familiar with teaspoon and tablespoon terms.

I asked Dr. Yin, from the New York University School of Medicine and Bellevue Hospital Center, to provide additional insight on the study’s implications, including what parents can do to reduce dosing errors. Our conversation, edited:
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NEHI: How To Save $84 Billion In Wasted Health Care Spending


NEHI, a Cambridge-based non-profit focused on innovation in health care, has just put out a three-pronged plan for cutting wasteful medical spending by $84 billion a year nationwide.
In brief, according to NEHI:

Emergency Department Overuse: More than half of the 120 million annual ED visits can be avoided, representing a $38 billion opportunity for savings. Potential solutions address specific recommendations to improve the primary care system and employ primary care alternatives such as tele-health technology and retail clinics. Proposed policy recommendations include specific pathways to reforming payment structures for providers and providing financial incentives for patients. Continue reading