Preventing Home Medication Administration Errors

Abstract

Medication administration errors that take place in the home are common, especially when liquid preparations are used and complex medication schedules with multiple medications are involved; children with chronic conditions are disproportionately affected. Parents and other caregivers with low health literacy and/or limited English proficiency are at higher risk for making errors in administering medications to children in their care. Recommended strategies to reduce home medication errors relate to provider prescribing practices; health literacy–informed verbal counseling strategies (eg, teachback and showback) and written patient education materials (eg, pictographic information) for patients and/or caregivers across settings (inpatient, outpatient, emergency care, pharmacy); dosing-tool provision for liquid medication measurement; review of medication lists with patients and/or caregivers (medication reconciliation) that includes prescription and over-the-counter medications, as well as vitamins and supplements; leveraging the medical home; engaging adolescents and their adult caregivers; training of providers; safe disposal of medications; regulations related to medication dosing tools, labeling, packaging, and informational materials; use of electronic health records and other technologies; and research to identify novel ways to support safe home medication administration.

Assessment of the Availability and Accuracy of Dosing Devices Packaged with Oral Liquid Medications in the Ho Municipality of Ghana

“…This result suggests that the full potential of dosing devices may not have been completely exploited by the caregivers in the research by Beckett et al [ 9 ] and Sobhani et al [ 33 ]. Alternatively, the discordance between the results in the present study and the literature could be a result of improvement in the inherent accuracy of dosing devices; this is unlikely because it recently has been established in practice that dosing volume accuracy varies among caregivers regardless of the accuracy of the dosing device [ 9 , 15 ]. These findings highlight, in addition to having accurate dosing devices, the need for improved caregiver education regarding the use of different dosing devices.…”

“…Cups have been associated with more than three times higher likelihood of caregiver-based error than oral syringes; specifically, this is true for small-dose volumes. Caregivers may find cups to be inherently difficult to use because the entire cup may be wrongly considered to be the dose, the cup may not be placed on a level surface while measuring, or the markings and meniscus of measure may not be observed at eye level [ 15 ]. Although the syringe has been determined to be the most accurate dosing device in this study, using a 5 mL syringe to dispense a 7.5 mL dose will result in the need to fill the syringe multiple times, which will rely heavily on caregiver numeracy skills.…”

“…A study assessing compliance of OTC liquid products with these guidelines showed a glaring need for improvements in dosing devices for these products, with 98.6% of products having a discrepancy between the dose on the label and the measuring device in the package [ 10 ]. There are reports of adherence to the recommendations [ 14 ]; however, dosing device availability remains woefully inadequate as it is still not a standard practice for dosing tools to be provided in the clinical or community pharmacy setting [ 7 , 15 ]. Further, the provision of dosing devices for prescription medications is inadequate compared to OTC medications.…”

“…Most studies on dosing devices describe dosing accuracy by caregivers [ 15 , 17 , 18 ]. In terms of dosing by caregivers, previous research has generated varied conclusions on measuring spoon accuracy.…”

Clinical action plans make a difference at point-of-care

“…The Green-Yellow-Red ‘stoplight system’ is a common CAP framework that divides the plan into colored zones which correspond to worsening clinical signs and symptoms: Green for good, Yellow for Bad, Red for Worse (or similar distinction). The UMS is an AHRQ-recommended feature designed to prevent medication errors by presenting pharmacotherapy dosing frequencies using 4 specific times of day (e.g., ‘morning,’ ‘noon,’ ‘evening,’ and ‘bedtime’ instead of as the number of times per day) [1 ▪▪ ]. CAPs can also be enhanced with clinical pictograms which direct patients and/or caregivers to recignize worsening disease signs and/or to escalate pharmacotherapy care at home.…”