Video Abstracts -- brief videos summarizing key findings of new articlesLiquid Medication Errors and Dosing Tools: A Randomized Controlled Experiment
Article Figures & Data
Figures
- FIGURE 1
Medication labels and dosing tools tested. A, Comparison of randomization group characteristics. Unit label and dosing tool pairings were chosen because they represent the most common current standard practices used to display dose amounts on medication labels and dosing tools. The combination of units on labels and dosing tools applied to 3 different dosing tools given to each person (2 oral syringes [1 0.2-mL increment and 1 0.5-mL increment] and 1 cup); each subject measured 3 doses with the 3 tools, for a total of 9 doses. aExample of group 2 medication label is shown in Fig 1B. Teaspoon units on English-language medication labels were translated into Spanish, consistent with recommended pharmacy practices. The abbreviation tsp was displayed as cdta on Spanish-language medication bottle labels, and teaspoon was displayed as cucharadita on the Spanish-language medication bottle labels. bDosing tools had units marked in English only, as is standard practice in the United States. For dosing tools, mL and tsp tools are most commonly used and were therefore included for the majority of groups. See Fig 1C. cThe milliliter-only system is endorsed by the AAP, the Centers for Disease Control and Prevention, and other national organizations. B, Example of group 2 medication label (English). C, Dosing tools tested.
- FIGURE 2
Study enrollment flowchart. aRan out of time after signing consent.
- FIGURE 3
Dosing errors by tool type across the 3 doses tested.
Tables
- TABLE 1
Characteristics of Study Population (n = 2099)a
Entire Population Group 1 Group 2 Group 3 Group 4 Group 5 P Label Unit mL mL and tsp mL and teaspoon mL teaspoon Dosing Tool Unit mL mL and tsp mL and tsp mL and tsp mL and tsp N = 417 N = 425 N = 421 N = 418 N = 418 Mean (SD) or n (%) Mean (SD) or n (%) Mean (SD) or n (%) Mean (SD) or n (%) Mean (SD) or n (%) Mean (SD) or n (%) Child characteristics Age, y, mean (SD) 2.0 (2.2) 2.1 (2.2) 2.3 (2.3) 2.0 (2.1) 2.0 (2.1) 1.9 (2.1) .2 Gender, n (%) female 987 (47.0) 206 (49.4) 210 (49.4) 196 (46.6) 181 (43.3) 194 (46.4) .4 Chronic medical problem treated with medication, n (%)b 352 (16.8) 74 (17.7) 64 (15.1) 64 (15.2) 76 (18.2) 74 (17.7) .6 Parent characteristics Age, y, mean (SD) 30.0 (7.3) 29.9 (7.1) 30.2 (7.5) 29.1 (7.1) 29.8 (7.5) 29.5 (7.5) .3 Gender, n (%) female 1930 (91.9) 384 (92.1) 397 (93.4) 391 (92.9) 384 (91.9) 374 (89.5) .3 Relationship to child, n (%) mother 1881 (89.6) 376 (90.2) 384 (90.4) 379 (90.0) 375 (89.7) 367 (87.8) .8 Marital status single, n (%)c 803 (38.7) 160 (38.8) 166 (39.6) 157 (37.7) 167 (40.3) 153 (37.0) .9 Income, n (%) .02 <$10 000 497 (23.7) 113 (27.1) 99 (23.3) 85 (20.2) 104 (24.9) 96 (23.0) $10 000–$19 999 554 (26.4) 94 (22.5) 114 (26.8) 144 (34.2) 107 (25.6) 95 (22.7) $20 000–$39 999 583 (27.8) 109 (26.1) 122 (28.7) 107 (25.4) 111 (26.6) 134 (32.1) ≥$40 000 255 (12.1) 55 (13.2) 47 (11.1) 48 (11.4) 56 (13.4) 49 (11.7) Unknown or missing 210 (10.0) 46 (11.0) 43 (10.1) 37 (8.8) 40 (9.6) 44 (10.5) Country of birth: non-US born, n (%)d 1031 (49.5) 203 (49.2) 230 (54.4) 201 (48.2) 201 (48.2) 196 (47.3) .3 Race or ethnicity, n (%)e .9 Hispanic 1140 (54.8) 224 (54.4) 227 (53.8) 225 (54.2) 241 (57.8) 223 (53.9) Non-Hispanic White, non-Hispanic 79 (3.8) 14 (3.4) 14 (3.3) 15 (3.6) 18 (4.3) 18 (4.3) Black, non-Hispanic 695 (33.4) 141 (34.2) 146 (34.6) 134 (32.3) 134 (32.1) 140 (33.8) Other, non-Hispanic 166 (8.0) 33 (8.0) 35 (8.3) 41 (9.9) 24 (5.8) 33 (8.0) Language Spanish, n (%)f 736 (35.1) 157 (37.6) 158 (37.2) 134 (31.8) 145 (34.7) 142 (34.0) .4 Education, n (%)g .9 Less than high school graduate 638 (30.7) 132 (32.0) 137 (32.5) 118 (28.3) 128 (30.8) 123 (29.7) High school graduate or equivalent 674 (32.4) 127 (30.8) 141 (33.4) 138 (33.1) 138 (33.3) 130 (31.4) Higher than high school graduate 769 (37.0) 154 (37.3) 144 (34.1) 161 (38.6) 149 (35.9) 161 (38.9) Health literacy, n (%)h .04 Low 740 (36.0) 148 (36.5) 139 (33.4) 142 (34.6) 157 (38.1) 154 (37.2) Marginal 843 (41.0) 166 (40.9) 191 (45.9) 167 (40.7) 175 (42.5) 144 (34.8) Adequate 475 (23.1) 92 (22.7) 86 (20.7) 101 (24.6) 80 (19.4) 116 (28.0) Site characteristics Emory 690 (32.9) 137 (32.9) 140 (32.9) 138 (32.8) 137 (32.8) 138 (33.0) .97 New York University 701 (33.4) 141 (33.8) 141 (33.2) 140 (33.3) 139 (33.3) 140 (33.5) Stanford 708 (33.7) 139 (33.3) 144 (33.9) 143 (34.0) 142 (34.0) 140 (33.5) ↵a Characteristics not different between enrolled subjects and those eligible who did not enroll (P > .05 for all).
↵b Missing for 56 children overall (16 in group 1, 11 in group 2, 12 in group 3, 5 in group 4, and 12 in group 5).
↵c Missing for 25 parents (5 in group 1, 6 in group 2, 5 in group 3, 4 in group 4, and 5 in group 5).
↵d Missing for 15 parents (4 in group 1, 2 in group 2, 4 in group 3, 1 in group 4, and 4 in group 5).
↵e Missing for 19 parents (5 in group 1, 3 in group 2, 6 in group 3, 1 in group 4, and 4 in group 5).
↵f Language of survey administration.
↵g Missing for 18 parents (4 in group 1, 3 in group 2, 4 in group 3, 3 in group 4, 4 in group 5).
↵h Health literacy measured with the Newest Vital Sign (low = score 0–1, marginal = 2–3, adequate = 4–6). Data missing for 41 subjects who did not complete the Newest Vital Sign (11 in group 1, 9 in group 2, 11 in group 3, 6 in group 4, and 4 in group 5).
- TABLE 2
Dosing Error by Dosing Tool Type and Randomization Group (n = 2058)
Dosing Error (>20% Deviation) Large Dosing Error (>2 Times the Dose) % Trials With Errors/Parenta Pb aORc 95% CI P % Trials With Large Errors/Parenta Pb aORc 95% CI P Group Label Unit Tool Unit Unit of measurement pairing on label versus dosing tool 1 mL mL 25.3 .002 1.0 Ref Ref 2.9 .08 1.0 Ref Ref 2 mL and tsp mL and tsp 22.8 — 0.9 0.7–1.04 .1 2.7 — 1.0 0.7–1.4 .9 3 mL and teaspoon mL and tsp 22.9 — 0.9 0.7–1.03 .1 3.0 — 1.1 0.8–1.6 .7 4 mL mL and tsp 25.4 — 1.0 0.8–1.2 .8 3.5 — 1.2 0.8–1.7 .4 5 teaspoon mL and tsp 29.6 — 1.2 1.01–1.4 .04 3.6 — 1.4 0.97–1.9 .08 Dosing tool type Cup 43.0 <.001 4.6 4.2–5.1 <.001 5.8 <.001 3.8 3.1–4.7 <.001 Syringe (0.2-mL increment, 10-mL capacity) 16.7 — 1.0 0.96–1.1 .4 1.8 — 1.0 0.8–1.3 .9 Syringe (0.5-mL increment, 10-mL capacity) 16.2 — 1.0 Ref Ref 1.8 — 1.0 Ref Ref - TABLE 3
Dosing Error by Dosing Tool Type and Randomization Group, Stratified by Health Literacy and Language (n = 2058)
% Trials With Errors/Parenta Dosing Error (>20% deviation) Pb aORc 95% CI P By Health Literacy Low health literacy (n = 740) Unit of measurement pairing on label vs dosing tool Group Label Unit Tool Unit 1 mL mL 32.4 .03 1.0 Ref Ref 2 mL and tsp mL and tsp 28.5 0.8 0.6–1.1 .2 3 mL and teaspoon mL and tsp 30.2 0.9 0.7–1.2 .4 4 mL mL and tsp 31.9 1.0 0.7–1.3 .9 5 teaspoon mL and tsp 38.7 1.3 0.98–1.7 .07 Dosing tool type Cup 48.9 <.001 3.4 3.0–3.9 <.001 Syringe (0.2-mL increment, 10-mL capacity) 24.9 1.1 0.98–1.2 .1 Syringe (0.5-mL increment, 10-mL capacity) 23.6 1.0 Ref Ref Marginal health literacy (n = 843) Unit of measurement pairing on label vs dosing tool Group Label Unit Tool Unit 1 mL mL 21.8 .2 1.0 Ref Ref 2 mL and tsp mL and tsp 21.5 0.9 0.7–1.2 .6 3 mL and teaspoon mL and tsp 22.2 0.97 0.7–1.3 .8 4 mL mL and tsp 24.5 1.1 0.9–1.5 .4 5 teaspoon mL and tsp 28.6 1.3 0.95–1.7 .1 Dosing tool type Cup 43.1 <.001 5.6 4.8–6.6 <.001 Syringe (0.2-mL increment, 10-mL capacity) 13.8 1.0 0.9–1.2 .8 Syringe (0.5-mL increment, 10-mL capacity) 13.7 1.0 Ref Ref Adequate health literacy (n = 475) Unit of measurement pairing on label vs dosing tool Group Label Unit Tool Unit 1 mL mL 20.3 .2 1.0 Ref Ref 2 mL and tsp mL and tsp 16.3 0.9 0.6–1.3 .5 3 mL and teaspoon mL and tsp 14.0 0.7 0.5–1.01 .1 4 mL mL and tsp 14.6 0.7 0.5–1.05 .1 5 teaspoon mL and tsp 18.8 0.9 0.7–1.4 .7 Dosing tool type Cup 33.6 <.001 6.5 5.0–8.5 <.001 Syringe (0.2-mL increment, 10-mL capacity) 8.2 0.9 0.7–1.2 .4 Syringe (0.5-mL increment, 10-mL capacity) 8.8 1.0 Ref Ref By Language English (n = 1334) Unit of measurement pairing on label vs dosing tool Group Label Unit Tool Unit 1 mL mL 25.6 0.2 1.0 Ref Ref 2 mL and tsp mL and tsp 22.0 0.8 0.7–1.02 .07 3 mL and teaspoon mL and tsp 21.3 0.8 0.6–0.96 .02 4 mL mL and tsp 23.7 0.9 0.7–1.06 .2 5 teaspoon mL and tsp 25.2 0.9 0.7–1.1 .4 Dosing tool type Cup 42.0 <.001 5.2 4.5–5.9 <.001 Syringe (0.2-mL increment, 10-mL capacity) 14.2 1.0 0.9–1.1 .8 Syringe (0.5-mL increment, 10-mL capacity) 14.3 1.0 Ref Ref Spanish (n = 724) Unit of measurement pairing on label vs dosing tool Group Label Unit Tool Unit 1 mL mL 24.9 <.001 1.0 Ref Ref 2 mL and tsp mL and tsp 24.1 1.0 0.8–1.3 .9 3 mL and teaspoon mL and tsp 26.5 1.1 0.8–1.4 .7 4 mL mL and tsp 28.7 1.2 0.9–1.6 .2 5 teaspoon mL and tsp 38.3 2.0 1.5–2.6 <.001 Dosing tool type Cup 44.7 <.001 3.9 3.3–4.5 <.001 Syringe (0.2-mL increment, 10-mL capacity) 20.8 1.1 0.98–1.2 .1 Syringe (0.5-mL increment, 10-mL capacity) 19.5 1.0 Ref Ref Ref, referent.
↵a Percentage of trials with dosing errors per parent.
↵b Type 3 χ2 from full model.
↵c Full model adjusting for randomization group, tool type, dose amount, dosing order, language, and health literacy. Models by health literacy adjusting for all except health literacy; models for language adjusting for all except language.
