Yin H Shonna, Parker Ruth M, Sanders Lee M, Mendelsohn Alan, Dreyer Benard P, Bailey Stacy Cooper, Patel Deesha A, Jimenez Jessica J, Kim Kwang-Youn A, Jacobson Kara, Smith Michelle C J, Hedlund Laurie, Meyers Nicole, McFadden Terri, Wolf Michael S
Department of Pediatrics, New York University School of Medicine, NYC Health + Hospitals/Bellevue, New York, New York;
Department of Population Health, New York University School of Medicine, New York, New York.
Pediatrics. 2017 Jul;140(1). doi: 10.1542/peds.2016-3237.
Poorly designed labels and dosing tools contribute to dosing errors. We examined the degree to which errors could be reduced with pictographic diagrams, milliliter-only units, and provision of tools more closely matched to prescribed volumes.
This study involved a randomized controlled experiment in 3 pediatric clinics. English- and Spanish-speaking parents ( = 491) of children ≤8 years old were randomly assigned to 1 of 4 groups and given labels and dosing tools that varied in label instruction format (text and pictogram, or text only) and units (milliliter-only ["mL"] or milliliter/teaspoon ["mL/tsp"]). Each parent measured 9 doses of liquid medication (3 amounts [2, 7.5, and 10 mL] and 3 tools [1 cup, 2 syringes (5- and 10-mL capacities)]) in random order. The primary outcome was dosing error (>20% deviation), and large error (>2× dose).
We found that 83.5% of parents made ≥1 dosing error (overdosing was present in 12.1% of errors) and 29.3% of parents made ≥1 large error (>2× dose). The greatest impact on errors resulted from the provision of tools more closely matched to prescribed dose volumes. For the 2-mL dose, the fewest errors were seen with the 5-mL syringe (5- vs 10-mL syringe: adjusted odds ratio [aOR] = 0.3 [95% confidence interval: 0.2-0.4]; cup versus 10-mL syringe: aOR = 7.5 [5.7-10.0]). For the 7.5-mL dose, the fewest errors were with the 10-mL syringe, which did not necessitate measurement of multiple instrument-fulls (5- vs 10-mL syringe: aOR = 4.0 [3.0-5.4]; cup versus 10-mL syringe: aOR = 2.1 [1.5-2.9]). Milliliter/teaspoon was associated with more errors than milliliter-only (aOR = 1.3 [1.05-1.6]). Parents who received text only (versus text and pictogram) instructions or milliliter/teaspoon (versus milliliter-only) labels and tools made more large errors (aOR = 1.9 [1.1-3.3], aOR = 2.5 [1.4-4.6], respectively).
Provision of dosing tools more closely matched to prescribed dose volumes is an especially promising strategy for reducing pediatric dosing errors.
设计不佳的标签和给药工具会导致给药错误。我们研究了使用象形图、仅用毫升为单位以及提供与规定剂量更匹配的工具能够在多大程度上减少错误。
本研究在3家儿科诊所进行了一项随机对照试验。将年龄≤8岁儿童的讲英语和西班牙语的家长（n = 491）随机分为4组，给予标签和给药工具，这些标签和工具在标签说明格式（文字和象形图，或仅文字）和单位（仅毫升 ["mL"] 或毫升/茶匙 ["mL/tsp"]）方面有所不同。每位家长按随机顺序测量9剂液体药物（3种剂量 [2、7.5和10 mL] 和3种工具 [1个杯子、2个注射器（容量分别为5 mL和10 mL）]）。主要结局是给药错误（偏差>20%）和重大错误（>2倍剂量）。
我们发现83.5%的家长出现了≥1次给药错误（12.1%的错误为过量给药），29.3%的家长出现了≥1次重大错误（>2倍剂量）。对错误影响最大的是提供与规定剂量更匹配的工具。对于2 mL剂量，使用5 mL注射器时错误最少（5 mL注射器与10 mL注射器相比：调整后的优势比 [aOR] = 0.3 [95%置信区间：0.2 - 0.4]；杯子与10 mL注射器相比：aOR = 7.5 [5.7 - 10.0]）。对于7.5 mL剂量，使用10 mL注射器时错误最少，该剂量无需多次装满量具进行测量（5 mL注射器与10 mL注射器相比：aOR = 4.0 [3.0 - 5.4]；杯子与10 mL注射器相比：aOR = 2.1 [1.5 - 2.9]）。毫升/茶匙单位比仅用毫升单位的错误更多（aOR = 1.3 [1.05 - 1.6]）。仅接受文字（与文字和象形图相比）说明或毫升/茶匙（与仅毫升相比）标签及工具的家长出现更多重大错误（分别为aOR = 1.9 [1.1 - 3.3]，aOR = 2.5 [1.4 - 4.6]）。
提供与规定剂量更匹配的给药工具是减少儿科给药错误的一项特别有前景的策略。
