OBJECTIVES A potential cause of medication errors in children is imprecise measurements, particularly using household spoons. There are no regulations requiring dispensing dose delivery devices (DDDs) with liquid prescription medications. Local, regional, and national pharmacy practice patterns are largely unknown. This study sought to determine how frequently devices are provided with prescription pediatric liquid medications with instructions for their use at pharmacies in Bronx, New York, and to examine which pharmacy and pharmacist characteristics are associated with reported practices.METHODS All pharmacies in Bronx, New York, were identified using an online telephone directory. A telephone survey was administered to the senior-level pharmacist that elicited availability of DDDs, whether pharmacy policy regarding dispensing devices existed, the pharmacist's personal practice of dispensing devices, and years in practice. RESULTSIn total, 268 pharmacies were contacted; 214 had free DDDs (79.9%) most of the time, 97.8% had them available to buy, and 160 (59.7%) had no policy regarding dispensing devices. Overall, 199 pharmacists (74.3%) routinely dispensed devices, and 195 (73.3%) demonstrated the use of devices. However, 94 pharmacists (35.3%) recommended using a household spoon to measure correct doses at least some of the time. Pharmacists were less likely to give devices as their years in practice increased.CONCLUSIONS In our study, many Bronx pharmacies had no policy regarding dispensing DDDs for prescription liquid medications, and dispensing practices varied among pharmacists based on years in practice. If similar trends are found in other areas, standardizing pharmacy policy and pharmacists' practices may decrease morbidity in children due to medication measurement errors.ABBREVIATIONS DDD, dosage delivery devices

ObjectivesScalp lacerations are a common occurrence in the pediatric population. A preferred method of closure in a busy pediatric emergency department (PED) is skin staples, because of their ease of use and rapid application. However, using skin staples also demands that the child have a follow-up visit for their removal. This study examines whether caregivers can be taught how to safely remove their child's skin staples at home, obviating the need for a return clinic visit and its associated costs.MethodsThis is a prospective, convenience study of 30 children older than 4 years presenting with a scalp laceration that the attending physician chose to close with skin staples. Caregivers of enrolled children completed an initial survey and received training in skin staple removal in the PED. Upon discharge, caregivers were given the staple removal device and specific instructions indicating the date for staple removal and how to access an online video reviewing proper staple removal technique. Caregivers were contacted after anticipated staple removal for completion of a follow-up survey. We recorded caregiver success rate at staple removal and measured potential benefits with regard to lost wages, transportation costs, and missed school time. Data were analyzed using descriptive statistics.ResultsTwenty-eight (93%) of 30 enrolled caregivers were successful in completely removing their child's staples; one caregiver did not attempt removal and another was lost to follow-up. Twenty-five caregivers (83%) completed follow-up surveys. All caregivers reported that if given a future choice, they would prefer to remove their child's staples at home rather than return to a clinic and all said that they would be “very comfortable” if they needed to remove staples again in the future. Sixty-four percent of caregivers estimated that it would have taken greater than 2 hours to attend a clinic for staple removal. Thirty-two percent of caregivers would have lost greater than US $100 in wages. Eighty-eight percent of children would have missed school time, with 46% having to miss an entire school day.ConclusionsCaregivers who were taught how to remove their child's scalp staples in the PED before discharge were highly successful at home. Ninety-three percent of enrolled patients had their staples completely removed and no complications were reported. Benefits included avoiding lost wages, lost time attending a follow-up clinic, and lost time from school. Staple removal is a simple technique that can easily be taught to caregivers in a matter of minutes and lead to greater patient and parent satisfaction.