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 Tens of thousands of kids wind up in emergency rooms after
unintentional medicine overdoses each year, and the cause is often
badly labeled containers or unclear directions, said Dr. Ian Paul, a
pediatrician at Penn State Milton S. Hershey Children's Hospital and
lead author of new metric dosing guidelines from the American
Academy of Pediatrics (AAP).
"Even though we know metric units are safer and more accurate, too
many healthcare providers are still writing that prescription using
spoon-based dosing," said Paul. "Some parents use household spoons
to administer it, which can lead to dangerous mistakes.”
For example, he said, accidentally using a tablespoon instead of a
teaspoon would triple the dose.
To avoid errors associated with common kitchen spoons, the
guidelines urge that liquid medicines being taken by mouth should be
dosed using milliliters (abbreviated as "mL").
Also, prescriptions should include so-called leading zeros, such as
0.5 for a half mL dose, and exclude so-called trailing zeroes, such
as 0.50, to reduce the potential for parents to misunderstand the
dosing.
While the AAP has been pushing for more accurate dosing of
children's medicines since the 1970s, the new guidelines are the
most extensive call for metric dosing to date and are intended to
reach drug manufacturers, retailers, pharmacists, prescribers and
caregivers.
"For this to be effective, we need not just the parents and families
to make the switch to metric, we need providers and pharmacists
too," said Paul.
Manufacturers should eliminate labeling, instructions and dosing
devices that contain non-metric units, the guidelines suggest.
Cups or syringes provided with medicines should be labeled in metric
units, and not be much larger than the maximum dose.
Ideally, the drugs should be dispensed with syringes that have a
flow meter because that's the most accurate way to measure liquid,
said Robert Poole, director of the pharmacy at Lucile Packard
Children's Hospital Stanford.
Parents can put the syringe in the side of the child’s mouth and
release the medicine slowly. “It's easier for the child to swallow
and you know the dose you get into the child is accurate," said
Poole, who wasn't an author of the guidelines. "Those little cups
that come with the medicine should really only be used to pour out
liquid that you then draw into an oral syringe."
In addition, electronic health records should make it impossible for
non-metric doses to be prescribed by clinicians or processed at
pharmacies, the guidelines suggest.
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To avoid overdoses and errors, weight and body temperatures should
also be recorded in kilograms and degrees Celsius rather than in
pounds and Fahrenheit, said Lois Parker, a pediatric pharmacist at
Massachusetts General Hospital in Boston.
"Weight is a source of medication errors because if the parent
reports the weight in pounds and we base the dosing on kilograms
that can lead to the wrong dose," said Parker, who wasn't involved
in the AAP guidelines.
Among prescription drugs, narcotics present the biggest overdose
dangers, said Dr. Brian Smith, a pediatrician at Duke University who
wasn't involved in writing the AAP guidelines. Kids who are the
sickest, who go home from the hospital with numerous medicines, are
often the most vulnerable to errors as parents struggle to keep
track of the dosing and timing for all of the drugs.
For over-the-counter drugs, Smith worries the most about
acetaminophen (Tylenol), because overdoses can lead to liver
failure. It's also dangerous to give children a wide variety of
nonprescription drugs at the same time, because they might
accidentally get more than one medicine with the same ingredient,
leading to unintended overdoses.
"Kids do get overdosed; it happens in the hospital with all of these
safeguards in place and it happens at home," said Smith. "Kids come
to the emergency room with unintentional overdoses and they get sick
and some kids die. Anything we do to reduce errors by making the
dosing clearer will save lives."
SOURCE: http://bit.ly/1kCYrQ1
Pediatrics, online March 30, 2015.
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