Effect of Medication Label Units of Measure on Parent Choice of Dosing Tool: A Randomized Experiment

• Type of Material: Article
• Authors: H. Shonna Yin, New York University; Ruth Parker, Emory University; Lee M. Sanders, Stanford University; Benard P. Dreyer, New York University; Alan Mendelsohn, New York University; Stacy Bailey, University of North Carolina; Deesha A. Patel, Northwestern University; Jessica J. Jimenez, New York University; Kwang-Youn A. Kim, Northwestern University; Kara Jacobson, Emory University; Laurie Hedlund, Northwestern University; Rosa Landa, Stanford University; Leslie Maness, New York University; Purvi Tailor Raythatha, New York University; Terri McFadden, Emory University; Michael S. Wolf, Northwestern University
• Language: English
• Date: 2016-11
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 Academic Pediatric Association
• Final Published Version (URL): http://dx.doi.org/10.1016/j.acap.2016.04.012
• Title of Journal or Parent Work: Academic Pediatrics
• ISSN: 1876-2859
• Volume: 16
• Issue: 8
• Start Page: 734
• End Page: 741
• Grant/Funding Information: Dr. Yin is supported by HRSA Grant 12-191-1077- Academic Administrative Units in Primary Care. Dr. Sanders is supported by FDA CERSI grant (UCSF-Stanford CERSI Award #13).; Supported by the National Institutes of Health (NIH)/National Institute of Child Health and Human Development (R01HD070864).
• Keywords: ambulatory care; Science & Technology; health literacy; health communication; CHILDREN; INSTRUCTIONS; ERRORS; HEALTH-LITERACY; ASSOCIATION; medication errors; INSTRUMENTS; CARE; dosing errors; Pediatrics; Life Sciences & Biomedicine; LIQUID MEDICATION; injury prevention
• Research Categories: Health Sciences, Pharmacy; Health Sciences, Public Health

Abstract

Objective Some experts recommend eliminating “teaspoon” and “tablespoon” terms from pediatric medication dosing instructions, because these terms could inadvertently encourage use of nonstandard tools (ie, kitchen spoons), which are associated with dosing errors. We examined whether use of “teaspoon” or “tsp” on prescription labels affects parents’ choice of dosing tools, and the role of health literacy and language. Methods Analysis of data collected as part of a controlled experiment (SAFE Rx for Kids [Safe Administration For Every Prescription for Kids] study), which randomized English- and Spanish-speaking parents (n = 2110) of children 8 years of age and younger to 1 of 5 groups, which varied in unit of measurement pairings on medication labels and dosing tools. Outcome assessed was parent self-reported choice of dosing tool. Parent health literacy was measured using the Newest Vital Sign. Results Seventy-seven percent had limited health literacy (36.0% low, 41.0% marginal); 35.0% completed assessments in Spanish. Overall, 27.7% who viewed labels containing either “tsp” or “teaspoon” units (alone or with “mL”) chose nonstandard dosing tools (ie, kitchen teaspoon, kitchen tablespoon), compared with 8.3% who viewed “mL”-only labels (adjusted odds ratio [AOR]  = 4.4 [95% confidence interval (CI), 3.3–5.8]). Odds varied based on whether “teaspoon” was spelled out or abbreviated (“teaspoon”-alone: AOR = 5.3 [95% CI, 3.8–7.3] ); “teaspoon” with mL: AOR = 4.7 [95% CI, 3.3–6.5]; “tsp” with mL: AOR = 3.3 [95% CI, 2.4–4.7] ; P  <  .001). Similar findings were noted across health literacy and language groups. Conclusions Use of teaspoon units (“teas poon” or “tsp”) on prescription labels is associated with increased likelihood of parent choice of nonstandard dosing tools. Future studies might be helpful to examine the real-world effect of eliminating teaspoon units from medication labels, and identify additional strategies to promote the safe use of pediatric liquid medications.