Primary Care Provider Perceptions and Practices Regarding Dosing Units for Oral Liquid Medications

• Published in: Academic pediatrics Vol. 18; no. 4; pp. 405 - 408
• Main Authors: Lovegrove, Maribeth C., Sapiano, Mathew R.P., Paul, Ian M., Yin, H. Shonna, Wilkins, Tricia Lee, Budnitz, Daniel S.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-05-2018
• Subjects: dosing devices; dosing errors; electronic health records; electronic prescribing; medication errors; metric units; electronic prescribing; electronic health records; dosing devices; metric units; dosing errors; medication errors
• ISSN: 1876-2859; 1876-2867
• DOI: 10.1016/j.acap.2017.12.002

To prevent errors, health care professional and safety organizations recommend using milliliters (mL) alone for oral liquid medication dosing instructions and devices. In 2018, for federal incentives under the Quality Payment Program, one requirement is for electronic health records to automatically use mL alone whenever oral liquid medications are prescribed. Current perceptions and practices of primary care providers (PCPs) regarding dosing units for oral liquid medications were assessed.
Pediatricians, family practitioners, nurse practitioners, and internists participating in the 2015 DocStyles Web-based survey were asked about their perceptions and practices regarding dosing units for oral liquid medications.
Three fifths of PCPs (59.0%) reported that using mL alone is safest for dosing oral liquid medications; however, nearly three quarters (72.0%) thought that patients/caregivers prefer instructions that include spoon-based units. Within each specialty, fewer PCPs reported they would prescribe using mL alone than reported that using mL alone is safest (P < .0001 for all). Among PCPs who think milliliter-only dosing is safest, those who perceived patients/caregivers prefer including spoon-based units were less likely to prescribe using mL alone (odds ratio 0.45, 95% confidence interval 0.34–0.59). Pediatricians were more likely than other PCPs to report that it is safest to use mL alone (80.8% vs 54.7%) and that they would use mL alone when prescribing (56.8% vs 30.9%) (P < .0001 for both).
Because less than two thirds of pediatricians and one third of other PCPs would use mL alone in dosing instructions, additional education to encourage prescribing and communicating with patients/caregivers using mL alone may be needed.