Liquid medication dosing errors in children: role of provider counseling strategies.
OBJECTIVE
To examine the degree to which recommended provider counseling strategies, including advanced communication techniques and dosing instrument provision, are associated with reductions in parent liquid medication dosing errors.


METHODS
Cross-sectional analysis of baseline data on provider communication and dosing instrument provision from a study of a health literacy intervention to reduce medication errors. Parents whose children (<9 years) were seen in 2 urban public hospital pediatric emergency departments (EDs) and were prescribed daily dose liquid medications self-reported whether they received counseling about their child's medication, including advanced strategies (teachback, drawings/pictures, demonstration, showback) and receipt of a dosing instrument. The primary dependent variable was observed dosing error (>20% deviation from prescribed). Multivariate logistic regression analyses were performed, controlling for parent age, language, country, ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease status; and site.


RESULTS
Of 287 parents, 41.1% made dosing errors. Advanced counseling and instrument provision in the ED were reported by 33.1% and 19.2%, respectively; 15.0% reported both. Advanced counseling and instrument provision in the ED were associated with decreased errors (30.5 vs. 46.4%, P = .01; 21.8 vs. 45.7%, P = .001). In adjusted analyses, ED advanced counseling in combination with instrument provision was associated with a decreased odds of error compared to receiving neither (adjusted odds ratio 0.3; 95% confidence interval 0.1-0.7); advanced counseling alone and instrument alone were not significantly associated with odds of error.


CONCLUSIONS
Provider use of advanced counseling strategies and dosing instrument provision may be especially effective in reducing errors when used together.
Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY. Electronic address: yinh02@med.nyu.edu.
H Shonna
HS
Yin
Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Benard P
BP
Dreyer
Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Hannah A
HA
Moreira
Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Linda
L
van Schaick
Department of Pediatrics, New York University School of Medicine and Woodhull Medical Center, New York, NY.
Luis
L
Rodriguez
Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Susanne
S
Boettger
Department of Pediatrics, New York University School of Medicine and Bellevue Hospital Center, New York, NY.
Alan L
AL
Mendelsohn
D000284:Administration, Oral; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004304:Dosage Forms; D004636:Emergency Service, Hospital; D004864:Equipment and Supplies; D005260:Female; D057220:Health Literacy; D006801:Humans; D007223:Infant; D065186:Interrupted Time Series Analysis; D008297:Male; D008508:Medication Errors / Q000517:prevention & control*; D010290:Parents / Q000193:education*; D010353:Patient Education as Topic / Q000379:methods*; D055815:Young Adult
D004304:Dosage Forms
adherence; ambulatory care; health literacy; medication error; parents; patient communication; patient education