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Doctors find strategies to reduce medication errors among kids

By Kathryn Doyle

NEW YORK (Reuters Health) - Many kids are not taking their prescribed medications, or take an incorrect dose, due to weaknesses in the chain from prescribing to filling prescriptions to administering medication, according to a new review of past studies.

Between five and 27 percent of all pediatric medication orders result in children being prescribed or taking the wrong amount of the drug, and medication errors lead to approximately 7,000 deaths each year, the authors note.

There are ways to fix the problem, but they will require cooperation between doctors, pharmacists and families, said lead author Dr. Michael L. Rinke, a pediatrician at Children’s Hospital at Montefiore in Bronx, New York.

“There are lots of different ways to do it, lots of different targets,” he told Reuters Health.

He and his colleagues reviewed 63 studies looking at such strategies.

The differences between the studies made it difficult to say which interventions would work better than others, Rinke noted.

He said there's been more research on how doctors prescribe medications simply because that's easier to study than medication errors at home.

For instance, the researchers found that doctors who used preprinted prescription order sheets - which can be paper or electronic and are more legible, clear and standardized than handwritten orders - reduced prescribing errors by 27 to 82 percent.

Among doctors who entered prescription orders into a computer, those whose software included clinical guidelines, diagnostic criteria and computerized reminders also had fewer prescribing errors, Rinke's team reported in Pediatrics.

Doctors should also work with pharmacists and nurses, administering medications with the child in the hospital and teaching parents how to give medications at home, Rinke said.

Another study in the same issue of Pediatrics proposed one possible solution for reducing errors at home when giving kids liquid medication: switch to measuring doses in milliliters.

Some doctors or pharmacists still prescribe doses in tablespoons or teaspoons, the authors write.

Although people in the U.S. often aren't used to metric measurements, the new study shows "that many parents are able to understand how to dose using milliliters, and that parents who think of their child's dose in teaspoons or tablespoons are actually much more likely to make dosing errors,” said lead author Dr. H. Shonna Yin, from New York University School of Medicine.

She and her colleagues analyzed data from a larger study on medication errors, including almost 300 parents whose child had been prescribed a liquid medication at an emergency department. They recorded the prescribed dose, asked parents what dose they actually administered and at least once observed the parents administering the medication.

Parents who used teaspoon or tablespoon units were twice as likely to give the wrong amount of medicine as parents who only used milliliters, according to the results.

One in six parents used a non-standard instrument, like a kitchen spoon, to dose out the medications, and errors were much more common among these cases because kitchen spoons can vary greatly in size and shape.

Liquid medications often don’t come with a dosing device, such as a dropper or cup, Yin told Reuters Health in an email. Parents may not get one at the pharmacy either.

That is one of the many changes that would need to be made for the U.S. to fully adopt the milliliter standard, she said.

Using the milliliter system for dosing is “a great idea,” Rinke said. “It’s disheartening for me to see that people are still prescribing in teaspoons and tablespoons.”

SOURCE: http://bit.ly/1no0LuP and http://bit.ly/1qabj8J Pediatrics, online July 14, 2014.

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