American Academy of Pediatrics Recommends Ways to Prevent Home Medication Administration Errors

Children with chronic health problems who take multiple medications are more vulnerable to medication mistakes

When administering medications to children, it is relatively common to make mistakes, which can lead to serious consequences -- but these errors can be prevented. The American Academy of Pediatrics, in an new policy statement, “Preventing Home Medication Administration Errors,” reviews the evidence on how medication errors most commonly occur in the home and recommends ways to prevent them through better communication, labeling, standardized tools for dosing and other practices.

The policy statement, published in the December 2021 Pediatrics (published online Nov. 1), notes that more than half of U.S. children take one or more medications per week, and that children with chronic medical conditions are at higher risk of medication administration errors.

“There are many ways medication mistakes can be made, some of which stem from how the prescription was written or dispensed, or due to confusing measurement units or a language barrier,” said H. Shonna Yin, MD, MS, FAAP, an author of the report, which was written by the Council on Quality Improvement and Patient Safety and Committee on Drugs.

“There might be confusion when a child is scheduled to take multiple medications at different times of the day, especially if there is more than one caregiver. Or a parent might use a teaspoon from the kitchen for a medication that requires a precise dose. These are all areas where we can make improvements to help support caregivers.”

Liquid formulations are involved in more than 80% of pediatric home medication errors, according to research. One study showed that nearly half of caregivers gave a dose of medication that deviated more than 20% from what was prescribed after their child was discharged from the emergency department of a public hospital; one in four caregivers gave a dose that deviated by more than 40%.

The AAP recommends that physicians:

• Improve communication with caregivers and patients.
• Make medication regimens as simple as possible. For example, regimens in which acetaminophen and ibuprofen are given continuously in an alternating fashion are difficult to follow and prone to error, unless explicit instructions and charts are provided.
• Encourage the use of a standardized dosing tool with all liquid medications.
• Provide dose amount using milliliter units only, using the abbreviation “mL” and avoid spoon-based or nonmetric units.
• Provide oral syringes when dosing accuracy is essential, especially when smaller doses are recommended (e.g., <5 mL) and when medications are for a young child.
• Reconcile medications at all relevant patient encounters.
• Access educational modules and other resources for safe prescribing practices, health literacy-informed patient education and counseling, and safe storage and administration of home medications.

“We encourage families to ask questions about all the medications their children are taking -- including over-the counter drugs and vitamin supplements -- so the pediatrician can go over the instructions and make sure these medications can be safely taken together,” said Daniel R. Neuspiel, MD, MPH, FAAP, an author of the report. “We can help prevent unintended consequences, and make sure that medications are taken in a safe and effective way.”

The AAP offers multiple resources for parents at HealthyChildren.org. They include:

• Acetaminophen Dosing Tables for Fever and Pain in Children
• Ibuprofen Dosing Table
• Diphenhydramine Dosing Table
• How to Use Liquid Medicines for Your Child
• Using Over-the-Counter Medicines With Your Child
• Medication Safety Tips for Families
• Team Up With Your Child’s Doctor for the Best Care