Factors Affecting Dosing Errors in Pediatric Liquid Medications among Parent
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Abstract
Objective: To study the effect of drug viscosity, volume of medicine to be measured, dosing devices, units of volume on the drug label and health literacy (HL) on dosing errors of pediatric liquid medicines among parent. Methods: The study began by asking 333 parents of children under 12 years old to complete the THLA-W+ (Thai Health Literacy Assessment Using Word List with Extended Questions to Test Comprehension) to assess their HL. The participants were divided into those with adequate and inadequate levels of HL. Both groups were asked to measure the medicine under the conditions randomly chosen for them by the researchers. There were 8 conditions in the study: 2 levels of viscosity (low - high) x 2 units of volume (teaspoon or milliliter) x 2 devices (teaspoon or syringe). Each participant measured 5 volumes, i.e. half, 0.6, three-quarter, 1 and 1.5 teaspoons for those getting teaspoon as the volume unit, and 2.5, 3, 3.75, 5 and 7.5 milliliters for those getting milliliters as the volume unit. The data were analyzed using generalized estimating equation. Results: Device x unit x HL Interaction and device x unit x volume Interaction showed a statistically significant effect on dosing error. Viscosity had no effects on dosing error. Incongruence between unit of volume on drug label and measuring tool increased dosing error. Dosing error with teaspoon as a unit and teaspoon as a tool was less than that with teaspoon as a unit and syringe as a tool (absolute errors were 13.05-27.99% and 26.12-42.96%, respectively). In the case of teaspoon as unit of volume and teaspoon as device, 68.29% and 76.83% of subjects were able to accurately measure half and 1 teaspoon of the drug, respectively. However 47.56-57.31% of the participants were able to accurately measure the drug at the volume of 0.6, three-quarter and 1.5 teaspoons. When the unit of volume was milliliter and device was syringe, there were 85.88-96.47% of participants correctly measuring the drug. When unit of volume was ml and tool was syringe, it became an easy task to measure the medicine with 90% of participants with insufficient HL being able to measure medication correctly. If unit of volume was teaspoon and tool was teaspoon, 55.61% and 67.32% of those with insufficient and sufficient HL, respectively, were able to accurately measure the drug. Conclusion: Device x unit x HL Interaction and device x unit x volume Interaction showed a statistically significant effect on dosing error, while viscosity had no effects. Public health organizations should promote to the use of milliliters as unit volume on drug labels and distribute syringe when dispensing liquid medicine. Use teaspoon as volume unit and teaspoon as a device should be done only when the volume of the medication to be measured is half or one teaspoon. Dispensing of liquid medicine should avoid the incongruence between volume units and distributed dosing device.
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ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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