To syringe or not to syringe, that is the question
Resident Clinical Pearl (RCP) – March 2017
Kalen Leech-Porter, PGY2 iFMEM, Dalhousie University, Saint John, New Brunswick
Reviewed by Dr. David Lewis and Dr. Brian Ramrattan
Snapshot Summary:
Problem:
- Parents often give their children the wrong dose of medications.
Solution:
- Provide parents a syringe to draw up medications
- Describe the amount of medication in mL, not teaspoons or cc’s
- Make sure to give simple instructions
Preamble:
It is well known amongst health practitioners that accurate dosing in pediatrics is extremely important; even a small miscalculation can have catastrophic results, potentially even death. We double check and triple check our calculations to make sure we prescribe the correct weight based dose. This is an excellent practice, and one we should continue to be diligent with, but if we don’t give proper instructions to parents, our calculations will be in vain: in a recent study of parents observed preparing prescriptions for their children, 84% of them made a measurement error!
The Study:
In this randomized control study, 2110 parents were assigned to 5 different groups in an outpatient office setting. All groups got the same prescription for amoxicillin, and the parents were observed preparing the medication for their children (three times). The groups differed in the tools provided (measuring cup, syringe, or both) and how the units were described (mls, teaspoons or both). (See below).
Results:
Across all groups, 84.4% of parents made at least one measurement error (at least a 20% under/over dose). 21% of parents more than doubled the prescribed dose. The group with the fewest errors was group I: when prescriptions were only written in mLs, and only a syringe was provided. Using the measuring cup, 43% of parents made a dosing error compared to 16% with the syringes (p<0.001).
Parents with lower health literacy and from lower socioeconomic backgrounds were more likely to make mistakes, but like those with better literacy made fewer mistakes in the syringe only group versus the groups that included cups.
Conclusion:
When writing out pediatric liquid prescriptions, describe the medications in terms of mL and specify that the meds should be distributed with a syringe, or provide a syringe from the hospital. This study did not demonstrate whether having practice draw up medications reduced errors, however it seems prudent to have health care workers observe parents give a first dose in the ED if time permits.
See the SJRHEM Tylenol and Advil dosing sheets on our Patient Information Leaflet page
Reference:
