Reducing medication errors in the home

In spite of the best efforts of patients and caregivers, medication errors are all too common. A new policy statement offers multiple suggestions to decrease their incidence.

Even with the best of intentions, parents and children may make an error when it comes to administering pharmaceuticals in the home, including overdosing, using expired medications, or incorrect preparation. These errors can result in minor to very serious consequences. A policy statement in Pediatrics offered guidance on reducing the number of errors.1

One in 2 children takes at least 1 medication once a week. Previous research has shown that roughly 50% of caregivers gave a dose that varied by more than 20% from the prescription dosage instructions and nearly 25% gave a dose that varied by over 40%. Many caregivers also gave doses of over-the-counter medication outside of the recommended doses. As the statement notes, a single dosing mistake will likely not result in a clinically significant error, but consistent medications errors may lead to harm. Furthermore, over-the-counter medications and supplements may be seen as safe, but could cause significant harm when incorrectly used. Medication given in a regimen may be at increased risk of error with certain factors making it more likely, such as frequent dosing as well as alternating medications. Teenagers with less supervision as well as more than 1 caregiver can be at greater risk of medical error.

Recommendations to reduce medication administration errors include:

  • Promote improved communication to caregiver and patients
  • Simplify medication regimens
  • Communicate dosing in appropriate units, such as describe a dose in milliliters, rather than “give a spoonful”
  • Provide written patient education materials on appropriate medication use that uses the correct literacy level and language for families
  • Give an after-visit summary to families that includes medication instructions
  • Take extra time to confirm understanding when the patient will be using a higher-risk medication
  • Urge the use a standardized dosing tool for liquid medications
  • Give families oral syringes when accurate dosing is essential
  • Reconcile medications at every relevant patient encounter
  • Encourage families to bring either medications or a list of medications to every visit
  • Promote safe medication disposal techniques

Clinicians should also continue to advocate for child-proofing in medication packaging. Additionally, they should encourage changes to the labelling of over-the-counter drugs that would remove “ask your doctor” and replace it with more precise dosing instructions.

Reference

1. Yin H, Neuspiel D, Paul I. Preventing home medication administration errors. Pediatrics. November 1, 2021. Epub ahead of print. doi:10.1542/peds.2021-054666