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Unit of measurement used and parent medication dosing errors, study

15 July, 2014
Teaspoons Or Tablespoons? The Dangers Of Parents Medicating Their Kids Without The Metric System. By Chris Weller.medicaldaily.com.  July 15, 2014. Gerald Ford had gotten his way maybe this wouldn’t be happening. The American Academy of Pediatrics has just published a study that found 40 percent of parents incorrectly dosed their children’s medication, and researchers are implicating teaspoons and tablespoons as culprits. Today, there are three countries who don’t use the metric system: Libya, Myanmar, and the United States. 
Unit of measurement used and parent medication dosing errors, study
Jarabe
(Sertox)
medicineSimply mistaking a tablespoon for a teaspoon ends up overdosing a child with three times the medicine he or she requires. Photo courtesy of Shutterstock.We had every intention of doing so, with President Ford’s 1975 signing of the Metric Conversion Act. But Ford’s grand idea of assembling a United States Metric Board (USMB) eventually fizzled out by the late 1980s. Attempts to standardize the metric system in the U.S. regressed back to old habits of using customary units. And now, in a brilliant display of stubborn compromise, manufacturers must include both units on their labels, though the public remains free to choose how to measure.
It’s a choice the AAP frowns upon, as parents tend to confuse measurements that are imprecise or otherwise look similar. If they’re told to give their child a tsp. of medicine and mistake it for a tbsp., they end up giving the child three times the recommended dosage — 15 milliliters over five. Driving your car at 60 miles per hour or buying fabric at $2 per yard may not do much harm, but the stakes are somewhat higher for doctors who need to keep people alive.
Pediatrician Dr. Jennifer Shu told CNN that she won’t prescribe medications by any other standard than the metric system. “If I give a sample of a liquid medication in my office, I also give a syringe and show the parent where the marking is for the dose,” she said. By having each doctor in her practice prescribe the same way, using the same system, parents should have no doubt how much to give.
Teaspoons and tablespoons are the largest offenders. Parents in the study who used ordinary kitchen spoons to measure out their kids’ medicine made twice the errors as parents using milliliter devices only (42.5 percent vs 27.6 percent). The same parents made measurement mistakes roughly 40 percent of the time.
Metric units don’t only eliminate the hassle of spoons, the researchers argue. They also eliminate the language barrier. Numbers are understood by everyone, and the sooner parents of foreign backgrounds can adopt metric standards the quicker their kids can get better. In addition, the AAP believes a standardized system could reduce mix-ups between the U.S. and foreign suppliers as well as minimize the number of calls to poison control centers due to parental overdose, of which there are more than 10,000 each year.
According to the study, doctors’ offices across the country could improve the safety of their young patients by first intervening with how parents deliver medication. The best systems to use are those that everyone respects and finds legitimate. Such is the case with educational systems and social etiquette. Kitchen tools, however, may be best left to the art of cooking. The science of medicine is too precise to eyeball.
Source: Yin H, Dreyer B, Ugboaja D, et al. Unit of Measurement Used and Parent Medication Dosing Errors. Pediatrics. 2014. Abstract.
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Read also related: Generic Pill Size And Shape Could Determine Whether The Patient Will Adhere To Medication Regimen. By Justin Caba.medicaldaily.com. July 14, 2014. Common barriers that prevent patients from adhering to their medication regimen include cost, difficulty keeping up with dosage, confusion how and when to take it, and not feeling the medication is necessary. A recent study conducted at the Brigham and Women’s Hospital (BWH) suggests that patients who have suffered a heart attack will choose to continue or discontinue their necessary post-heart attack drug regimen based on the shape and color of generic pills.PillsThe size and shape of pills could determine whether the patient will adhere to their medication regimen.Photo courtesy of Shutterstock
"After patients have a first heart attack, guidelines mandate treatment with an array of long-term medications and stopping these medications may ultimately increase morbidity and mortality," Dr. Aaron S. Kesselheim, assistant professor of medicine in the Division of Pharmacoepidemiology and Pharmacoeconomics at BWH, said in a statement. "Medications are essential to the treatment of cardiovascular disease and our study found that pill appearance plays an important role in ensuring patients are taking the generic medications that they need."
Kesselheim and his colleagues analyzed the medical insurance records of over 10,000 patients discharged between 2006 and 2011 who received treatment after being hospitalized due to a heart attack. Medication options included generic beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin-II-receptor blockers, or cholesterol-lowering statins. The research team checked medical records for non-adherence to medication regimen by way of breaks in refills and determined if a change had occurred in the pill’s appearance.
The likelihood of a patient discontinuing use or failing to refill their medication increased by 34 percent when the pill changed in color and 66 percent when it changed in shape. According to the research team, generic versions of the same prescription drug more often than not carry the same degree of effectiveness, but can vary in appearance depending on the manufacturer. Since the Food and Drug Administration does not require that the look of a pill remain the same, patients will often receive medications that are different shapes and sizes reliant on their pharmacy’s supply.
"The association between changes in pill appearance and non-adherence to essential cardiovascular medications has important implications for public health," Kesselheim added. "This study suggests the need for physicians and pharmacists to proactively warn patients about the potential for these changes, and reassure them that generic drugs are clinically interchangeable no matter how they look, especially in light of the prevalent use of generic drugs and public health importance of promoting patient adherence to essential medications."

Source: Avorn J, Tong A, Kesselheim A, et al. Burden of Changes in Pill Appearance for Patients Receiving Generic Cardiovascular Medications After Myocardial Infarction: Cohort and Nested Case–Control Studies. Annals of Internal Medicine. 2014.   

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