COMMENTARY

CDC Expert Commentary: What to Tell Your Patients About Medication Safety

Dan Budnitz, MD, MPH

Disclosures

September 27, 2010

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Hello. I am Dan Budnitz, Director of the Office of Medication Safety at the Centers for Disease Control and Prevention (CDC).

I am speaking to you as part of the CDC Expert Commentary Series on Medscape.

As you probably know, medication use has increased significantly in recent years. In a given week, 86% of American adults and 56% of children use at least 1 medicine.

When we prescribe medicines to pediatric patients, we typically take time to explain how to take them to ensure effectiveness. But we usually spend far less time on how to ensure medication safety.

Findings from national data suggest 4 things busy clinicians can tell parents and older children about using medicines safely.

  1. Among children, unintended medication overdoses (rather than allergic reactions or side effects) are the most common cause of serious harm and lead to more than 70,000 emergency department visits every year.

  2. It is not errors by clinicians that cause most of these overdoses -- 80% are caused by unsupervised ingestions in the home, typically by 2-year-olds. One of every 180 2-year-olds is brought to an emergency department for a medication overdose.

  3. Dosing errors by parents cause fewer pediatric emergency visits (approximately 10% of medication overdoses) -- but certain dosing errors can cause serious harm, particularly for infants and toddlers.

  4. Approximately 10% of emergency visits for nonabuse overdoses involve innocent (but misguided) attempts by pre-adolescents and teens to self-treat pain or other symptoms with high doses of medicines. Pre-adolescents and teenagers may not appreciate the consequences of taking high doses of medicine, particularly of over-the-counter medicines.

To help prevent these overdoses, CDC encourages you to talk to parents and older children about the following ways to use medicines safely:

  • First, advise parents of infants and young children to put all medicines up and away and out of sight after every use. Many families have a designated safe place to store medicines, but, often, medicines currently being used are left in a different easily accessible place -- on the kitchen counter, or on a nightstand. But these locations are easy for children to access, too and medicines should never be kept there, even temporarily. Medicine that a child, a sibling, or an adult is currently taking should still be put up and away and out of sight after every use.

  • Encourage adults to lock child-resistant caps every time a medicine is used. If a child gets hold of a medicine bottle, the child-resistant cap provides some additional protection. But that cap must be firmly in place to work. Even when properly applied, child-resistant caps are not 100% child-"proof." New innovative packaging with enhanced child-resistant features is being developed. Today, some medicines are available in unit-dose packaging -- which may be safer because if children get into these packages, they may ingest a single dose, but hopefully not an entire bottle.

  • Tell parents of infants and young children to use the dosing device that comes with each medicine. Kitchen spoons are not designed to accurately measure medication. Both the US Food and Drug Administration, and the Consumer Healthcare Products Association have recommended that over-the-counter products include clearly labeled dosing devices that match the instructions on the bottle. If a dosing device does not come with a prescription medicine, parents should ask their pharmacist for one.

  • Ask pre-teens and adolescents about their medicine use, including over-the-counter medications, and remind them of serious harms of exceeding recommended doses. Also, counsel pre-teens and adolescents to never take someone else's prescription medicines.

In summary, to prevent emergency department visits for medication overdoses in your pediatric patients, I encourage you to:

  • Advise parents of toddlers to put all medicines up and away and out of sight after every use;

  • Encourage adults to lock child-resistant caps every time a medicine is used;

  • Tell parents of infants and young children to use the dosing device that comes with the medicine; and

  • Ask pre-teens and adolescents about their medicine use, including over-the-counter medications, and remind them of serious harms of taking too much.

To learn more about how CDC uses public health data to suggest medication safety interventions, visit www.cdc.gov/medicationsafety. Thank you.

Additional Web Resources

FDA. Medicines in My Home.

OTC Safety.org

Dan Budnitz, MD, MPH, CAPT, USPHS. Dr. Budnitz is the Director of CDC's Office of Medication Safety in the Division of Healthcare Quality Promotion. He has authored 30 publications on medication safety monitoring, using national medication safety data to target safety measures, and applying lessons from injury prevention to drug safety. Dr. Budnitz received a BA (government) from Harvard University, and a combined MD/MPH (epidemiology) from Emory University. After completing residency training in internal medicine at the Hospital of the University of Pennsylvania, he served as an Epidemic Intelligence Service (EIS) Officer with CDC's Injury Center. Dr. Budnitz is currently a Captain in the US Public Health Service; Clinical Assistant Professor of Internal Medicine, Emory University; and has practiced as a Board-certified internist at the Atlanta VA Medical Center and the DeKalb-Grady Neighborhood Health Center.

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