Evaluation of a method to reduce over-the-counter medication dosing error

Abstract

Objectives: To introduce a simple method of dosing over-the-counter medication in a home setting using a color-coding concept and to compare dosing deviation from recommended dosage using the color-coded method with dosing deviation using conventional package labeling.

Design: Randomized controlled clinical trial.

Setting: Pediatric emergency center at a tertiary care medical center.

Participants: A sample of 101 caregivers of children with nonemergent complaints separated into 2 groups. One group used a conventional dosing method and the other group used a color-coded method to determine and measure a dose of acetaminophen for their child.

Main outcome measures: For both dose determination and dose measuring, percentage of deviation from recommended acetaminophen dosage was calculated and compared between the 2 groups.

Results: There was no significant difference in sociodemographic characteristics between the 2 groups. How-ever, for dose determination, the average deviation (25.8% vs 1.7%) and median deviation (1% vs 0%) from recommended dosage were both higher for the group using conventional methods compared with the group using the color-coded method. The Wilcoxon rank sum test indicated that the median deviation was significantly different between the 2 groups (P<.001). Similar results were obtained for dose measuring. The average deviation (29% vs 0.5%) and the median deviation (17.2% vs 0%) from recommended dosage were higher for the group using conventional methods compared with the group using the color-coded method. The median deviation was also significantly different between the 2 groups (P<.001).

Conclusion: This study suggests a marked improvement in caregivers' ability to correctly determine and measure an over-the-counter medication for their child using a color-coded method compared with conventional methods.