AAP Pushes for Metric Dosing of Oral Liquid Meds in Children

Janis C. Kelly

March 30, 2015

Some 70,000 children are seen in emergency departments each year in the United States as a result of unintentional medication overdoses, sparking a push by the American Academy of Pediatrics (AAP) to move to all metric units for pediatric dosing.

"To reduce errors and increase precision of drug administration, milliliter-based dosing should be used exclusively when prescribing and administering liquid medications," says the AAP's Committee on Drugs Policy in a statement published online March 30 in Pediatrics.

The AAP also recommends getting kitchen spoons out of medication administration and cleaning up the way pediatric dosing prescriptions and instructions are written.

According to the committee, led by Ian M. Paul, MD, professor of pediatrics and public health sciences at Pennsylvania State University, State College, volumetric dosing errors and use of the wrong delivery device are frequent sources of medication overdose.

These problems are often compounded by discordance between medication labeling and dosage delivery devices, such as having metric dosing in milliliters on the label, but dosing in imperial or US customary units such as teaspoons on the dosing device, the authors write. Inconsistent abbreviations (such as mL, ml, ML, and cc for milliliter) add further confusion.

AAP Urges Simpler, Clearer, Metric-Only Pediatric Prescribing

To improve this situation, the AAP Policy Statement recommended:

  • use of metric-based dosing with milliliters for all orally administered liquid medications;

  • using only "mL" as the abbreviation for milliliters;

  • using leading zeros for doses less than 1 mL (eg, 0.5 mL) to avoid 10-fold dosing errors;

  • not using trailing zeros after decimals when dosing in whole-number units (eg, 5 mL) to avoid 10-fold dosing errors;

  • clearly specifying the medication concentration (mg/mL) on prescriptions;

  • clearly specifying frequency of administration (eg, "daily") without using potentially confusing abbreviations (eg, "qd," which could be misread as "qid");

  • reviewing milliliter-based doses with patients and families;

  • using metric units in electronic medical records and designing software so that providers cannot prescribe medications using non-milliliter-based dosing;

  • including metric dosing on the label for orally administered liquid medications dispensed by pharmacies, hospitals, and health centers;

  • including appropriate dosing devices (such as milliliter syringes) with the medication dispensed by pharmacies, hospitals, and health centers; and

  • having manufacturers eliminate labeling, instructions, and dosing devices in units other than metric.

Similar recommendations have been made by the Institute for Safe Medication Practices, the Academic Pediatric Association, the American Academy of Family Physicians, the American Medical Association, the National Council for Prescription Drug Programs, and the US Food and Drug Administration.

The authors have disclosed no relevant financial relationships.

Pediatrics. Published online March 30, 2015. Full text


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