Liquid medication dosing errors: a pre-post time series in India

Abstract

Objective To evaluate the influence of pharmacist intervention on the level of parental dosing measurement errors and paediatrician dosage prescribing in a clinic in India. Setting and study design The study was conducted at Srujan Hospital for Sick Children, India. It used a time series design with two groups of patients. Group 1 involved 175 children prescribed paracetamol and assigned to usual care. Following an educational intervention for the hospital paediatricians, including feedback on dosages prescribed for Group 1 and promotion of a dosing chart, 162 patients were recruited to the intervention group (Group 2). Parents in Group 1 received paracetamol suspension and verbal instructions from hospital staff (standard care). Parents in Group 2 were provided with a syringe with a line marking the prescribed dose and its use was demonstrated to them by the pharmacist. Data on the dosages prescribed and measurement accuracy by parents were obtained for both groups. Main outcome measures Measurement of correct dosages by parents, and prescribing of appropriate dosages by paediatricians. Results In Group 1, 85 of 175 parents (48.6%) measured the correct dose (§0.5 ml) and paediatricians prescribed appropriate dosages in 67 of 175 cases (38.2%). In Group 2, 160 of 162 parents (98.7%) measured the correct dose and paediatricians prescribed appropriate dosages in 160 of 162 cases (98.7%), showing statistically significant improvements in both indicators (P < 0.001). When the impact of prescribing and dosing correctness was combined on an individual patient basis, 76 of 175 (43.4%) were appropriate in Group 1, and 160 of 162 (98.7%) were appropriate in Group 2. There was a statistically significant improvement (P < 0.001) in appropriate dosing outcome between the two groups. Conclusion Pharmacist intervention through patient education, including the use of a syringe, significantly improved parents' dosing accuracy. Pharmacists' feedback resulted in a reduction in physicians' prescribing errors in a country where pharmacist involvement is currently minimal.