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Article

Unit of Measurement Used and Parent Medication Dosing Errors

H. Shonna Yin, Benard P. Dreyer, Donna C. Ugboaja, Dayana C. Sanchez, Ian M. Paul, Hannah A. Moreira, Luis Rodriguez and Alan L. Mendelsohn
Pediatrics August 2014, 134 (2) e354-e361; DOI: https://doi.org/10.1542/peds.2014-0395
H. Shonna Yin
aDepartment of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York;
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Benard P. Dreyer
aDepartment of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York;
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Donna C. Ugboaja
aDepartment of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York;
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Dayana C. Sanchez
aDepartment of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York;
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Ian M. Paul
bDepartment of Pediatrics, Pennsylvania State University College of Medicine, Hershey, Pennsylvania; and
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Hannah A. Moreira
aDepartment of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York;
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Luis Rodriguez
cDepartment of Pediatrics, New York University School of Medicine and Woodhull Medical Center, New York, New York
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Alan L. Mendelsohn
aDepartment of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, New York;
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Abstract

BACKGROUND AND OBJECTIVES: Adopting the milliliter as the preferred unit of measurement has been suggested as a strategy to improve the clarity of medication instructions; teaspoon and tablespoon units may inadvertently endorse nonstandard kitchen spoon use. We examined the association between unit used and parent medication errors and whether nonstandard instruments mediate this relationship.

METHODS: Cross-sectional analysis of baseline data from a larger study of provider communication and medication errors. English- or Spanish-speaking parents (n = 287) whose children were prescribed liquid medications in 2 emergency departments were enrolled. Medication error defined as: error in knowledge of prescribed dose, error in observed dose measurement (compared to intended or prescribed dose); >20% deviation threshold for error. Multiple logistic regression performed adjusting for parent age, language, country, race/ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease; site.

RESULTS: Medication errors were common: 39.4% of parents made an error in measurement of the intended dose, 41.1% made an error in the prescribed dose. Furthermore, 16.7% used a nonstandard instrument. Compared with parents who used milliliter-only, parents who used teaspoon or tablespoon units had twice the odds of making an error with the intended (42.5% vs 27.6%, P = .02; adjusted odds ratio=2.3; 95% confidence interval, 1.2–4.4) and prescribed (45.1% vs 31.4%, P = .04; adjusted odds ratio=1.9; 95% confidence interval, 1.03–3.5) dose; associations greater for parents with low health literacy and non–English speakers. Nonstandard instrument use partially mediated teaspoon and tablespoon–associated measurement errors.

CONCLUSIONS: Findings support a milliliter-only standard to reduce medication errors.

  • medication errors
  • health literacy
  • ambulatory care
  • health communication
  • Accepted April 23, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 134, Issue 2
1 Aug 2014
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Unit of Measurement Used and Parent Medication Dosing Errors
H. Shonna Yin, Benard P. Dreyer, Donna C. Ugboaja, Dayana C. Sanchez, Ian M. Paul, Hannah A. Moreira, Luis Rodriguez, Alan L. Mendelsohn
Pediatrics Aug 2014, 134 (2) e354-e361; DOI: 10.1542/peds.2014-0395

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Unit of Measurement Used and Parent Medication Dosing Errors
H. Shonna Yin, Benard P. Dreyer, Donna C. Ugboaja, Dayana C. Sanchez, Ian M. Paul, Hannah A. Moreira, Luis Rodriguez, Alan L. Mendelsohn
Pediatrics Aug 2014, 134 (2) e354-e361; DOI: 10.1542/peds.2014-0395
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