Elsevier

Journal of Pediatric Health Care

Volume 26, Issue 6, November–December 2012, Pages 443-450
Journal of Pediatric Health Care

Article
Women’s Understanding of Different Dosing Instructions for a Liquid Pediatric Medication

https://doi.org/10.1016/j.pedhc.2011.06.006Get rights and content

Abstract

Introduction

Dosing errors by caregivers are common and often are directly attributed to poorly designed instructions. The purpose of this study was to assess whether instruction wording—that is, implicit versus explicit dosage intervals—was associated with participants’ ability to describe and correctly measure a dose of a commonly prescribed liquid pediatric prescription medication.

Methods

English-speaking women (N = 193) of child-bearing age were recruited to participate in this study from an outpatient residency clinic in the southeastern United States. Based on a priori randomization, each participant was presented with one of two medication bottles that were identical except for the instructions: (1) “SHAKE LIQUID WELL AND GIVE (CHILD’S NAME) 6 ML BY MOUTH EVERY 12 HOURS” (“implicit” dosage interval),” or (2) “SHAKE LIQUID WELL AND GIVE (CHILD’S NAME) 6 ML BY MOUTH AT 7 AM AND 7 PM” (“explicit” dosage interval). Participants completed a structured interview to assess sociodemographic characteristics, health literacy skills, ability to describe and demonstrate the dosage of the liquid medication, and preferences for label format.

Results

Seventy-two participants (37.3%) were able to correctly describe how they would give the medicine to a child during a 24-hour period, while 145 women (75.1%) were able to correctly demonstrate how they would give one dose of the medication. Approximately one third of participants (32.1%) were able to correctly describe and measure a dose of the medication. Slightly more than half of participants (n = 103, 53.4%) indicated that they would prefer instructions with “explicit” dosage intervals.

Discussion

This study suggests that few people can accurately describe how liquid medications are to be administered, while more people can demonstrate the correct dose to be administered.

Section snippets

Participants and Procedures

A total of 193 women of child-bearing age were recruited to participate in this study from an outpatient obstetrics and gynecology residency clinic in the southeastern United States between May and July 2010. Eligibility criteria included being 21 to 45 years of age, English-speaking, and currently enrolled in TennCare (Medicaid). Potential participants who appeared too ill or had poor visual acuity were excluded. A research assistant (RA) approached patients while they were in the waiting room

Participants’ Sociodemographic Characteristics and Health Literacy Skills

The women averaged 29.1 ± 6.4 years of age. Most women were white (81.9%), married (58.0%), and currently lived with one or more children (80.3%). Almost one fifth (18.7%) of the women had not completed high school, and nearly half (48.7%) had inadequate HL skills. As expected in a randomized controlled trial, sociodemographic characteristics and HL skills did not differ between participants randomly assigned to either medication label instruction group (Table 1).

Description and Demonstration of Pediatric Liquid Medication Use

The majority of participants

Discussion

This study offers new findings regarding women’s ability to both describe and demonstrate use of a commonly prescribed liquid medication. Just over one third of respondents were able to correctly describe how they would administer the medication during a 24-hour period, and three quarters of respondents accurately demonstrated how they would administer one dose of the medication. In adjusted multivariate analyses, sociodemographic characteristics, HL skills, and label instruction format did not

Limitations

Our results should be considered in the context of several limitations. First, the ability to generalize these findings may be limited by the fact that participants were recruited from a single residency clinic in the southeastern United States. Second, participants initially were recruited on the basis of convenience and then randomly assigned to receive a medication bottle with implicit or explicit instructions, raising the possibility of selection bias in the overall group of study

Conclusions

This study suggests that few people can accurately describe how liquid medications are to be administered and that the inability to do so is not associated with sociodemographic factors, HL skills, or the wording of dosing instructions.

In a sample of 193 women attending an obstetrics and gynecology clinic, fewer than 40% correctly described how to administer a liquid pediatric medication, while an estimated 75% were able to demonstrate the correct dose to be administered. The ability to

Lorraine S. Wallace, Associate Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH.

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  • Cited by (0)

    Lorraine S. Wallace, Associate Professor, Department of Family Medicine, The Ohio State University College of Medicine, Columbus, OH.

    Amy J. Keenum, Associate Professor, University of Tennessee Graduate School of Medicine, Department of Family Medicine, Knoxville, TN.

    Jennifer E. DeVoe, Associate Professor, Oregon Health and Science University, Department of Family Medicine, Portland, OR.

    Shannon K. Bolon, Primary Care Medical Education Branch Chief, Health Resources and Services Administration, U.S. Department of Health & Human Services, Rockville, MD.

    Julie S. Hansen, Graduate Research Assistant, University of Tennessee Graduate School of Medicine, Knoxville, TN.

    Conflicts of interest: None to report.

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