Measuring Safety: Healthy Doses

Does Mary Poppins need a script doctor to rewrite a classic scene? Five decades ago, the famous Disney nanny sang about a “spoonful of sugar to help the medicine go down,” and in that 1964 movie, her advice seemed like a sweet dose of common sense. But now, medical authorities are raising red flags about the health hazards of using kitchen spoons to serve liquid medicines to kids.

There’s reason for concern: Every year, poison centers around the country receive a combined total of more than 10,000 calls from concerned parents or caretakers after a child was given the wrong dose of a liquid medication, according to published news reports. Those dosing problems are more likely to occur when a kitchen spoon is used for measurements.

“Don’t grab the kitchen spoon. It doesn’t give you a precise measurement, and increases the risk of an underdose or overdose of medicine,” says Javier Hiriart, M.D., a Baptist Health Medical Group internist and pediatrician at West Kendall Baptist Hospital.

The National Institutes of Health agrees and points to a recent study about the hazards that can develop when random kitchen spoons are used to dispense liquid medicine to children. The chances of errors are heightened when parents are confused or unaware of the difference between a teaspoon and a tablespoon.

The Problem
Here’s the data, which was published in a recent issue of Pediatrics, a medical journal:

About 40 percent of survey participants incorrectly measured the prescribed dose of medicine for a child.

Adults using kitchen teaspoons and tablespoons were twice as likely to pour the wrong amount of medicine or to make some other mistake related to the dose.

Approximately 30 percent of parents who were told to provide a teaspoon or tablespoon of medicine used any kitchen spoon to measure out the dose, and were 250 percent more likely (2.5 times) to give the wrong dose.

That’s a problem because the prescribed doses are often exact calculations based on a child’s weight, and even a little extra can raise the risk of adverse side effects or an overdose, Dr. Hiriart says. And at the other extreme, an underdose could seriously hamper the medicine’s ability to combat a fever, ear infection or other illness. And that’s especially true if you’re dealing with antibiotics, in which precise and complete doses are important to treatment, he says.

Problem Solvers
As a result of the data and the increased risk of errors, different medical and pharmacy groups are now pushing for new procedures for prescribing, dispensing and administering liquid medicine to children. The U.S. Centers for Disease Control & Prevention, the American Academy of Pediatrics and the Institute for Safe Medication Practices recommend that:

Doctors prescribe milliliter doses for children as opposed to prescriptions based on teaspoon or tablespoon measurements.

Pharmacists convert liquid prescription doses to precise volume measurements.

Small details matter, according to a report about medicine safety and children from the U.S. Food and Drug Administration:

“With measuring devices, pay attention to the small details. It can be easy to misread a measurement or a marking. You don’t want to give your child a tablespoon when you’re supposed to give him a teaspoon, or give her 5 milliliters (mls) when you’re supposed to give her 0.5 mls. Mistakes like this can be deadly.”

Other best practices include providing parents with either milliliter-based dosing syringes, volume cups or dispensing spoons at either the doctor’s office or at the pharmacy, Dr. Hiriart says.

“I’ve seen pharmacists take out a marker and clearly mark off on the dosing syringe how much medicine should be poured,” he says. “That step further reduces the room for error.”

And he has one more bit of medical advice for Mary Poppins: serve the medicine but hold off on the sugar.

Tags: accidental overdose, family medicine, Patient safety, pediatrics