John, the system problem is that teaspoonful is even allowed to be used in a prescription. As I mentioned, the Instiute of Safe Medication Practices (ISMP)---FINALLY, and in the year 2009!---recommended that household units be banned from the entire practice of healthcare (please see attached).
Yes, you're right, usually the mistake is in giving the volume to take, and yes, the pharmacist is the healthcare professional responsible for translating the dose into the correct volume for the caregiver to give the child. I wish the article had said which drug product was in question, but as a pharmacist I will guess that it was loratadine oral solution (Claritin) 5 mg/5 mL, an antihistamine for the baby's irritated ear canal, so the dosage volume would be 2 mL, and the dose placed on the label was 2 teaspoonfuls, or 10 mL. The prescription was either illegible or it was dispensed hastily, i.e, without taking into account that it was a pediatric patient. Still, there is no approved infant dose for Claritin, but 2 mg (2 mL) is a reasonable choice. The error still hinges upon the habit of using teaspoonfuls, or 5 mL increments of volume. Even if the prescription was dispensed in haste (which is very, very likely today when a pharmacy is dispensing 400 to 600 prescriptions per day), the prescribing and dispensing habits for oral liquid medication in our country continue to emphasize the teaspoonful. Even doctors who come from other (i.e., metric) countries get into the bad habit of using teaspoonfuls when they study medicine in the U.S. If ISMP's recommendations had been followed (i.e., no use of the teaspoonful by the prescriber, the pharmacist, or the patient), then there would be no use of the teaspoonful at all, and the dose would have to have been translated into milliliters by the pharmacist. Once again, there is also the possibility that the dose for a pediatric patient was not considered by the pharmacist who filled the prescription and, as too often happens, the prescription goes down the "assembly line" without being carefully checked. But the magnitude of the overdose still hinges upon our insistence upon considering this primitive 5 mL unit we call one teaspoonful. The baby received a five-fold overdose. ISMP has recommended the metrication oral liquid medication dosing in the U.S. It wasn't in place to protect this baby. Paul Paul Trusten, R.Ph. , Vice President U.S. Metric Association, Inc. www.metric.org [email protected] +1(432)528-8824 ----- Original Message ----- From: John M. Steele To: U.S. Metric Association Sent: 31 January, 2011 05:39 Subject: [USMA:49711] Re: a non-metric U.S. can kill children Paul, I don't understand this from the article: "The boys father says he was diagnosed with an ear infection and given the wrong dosage by a 24-hour pharmacy, 2 teaspoons instead of 2 milligrams." If the dose printed was 2 tsp, it must have been a liquid medicine. It may have been a reporter error ( 2 mL??), but the dose should have been a volume in milliliters. If doctors, pharmacists, or vets (in the case of pet owners) believe the public can work concepts of weight based dosing or concentrations of liquid medicine, they are wrong. I help out at a conversion site, and there is endless confusion over the concepts. The doctor or pharmacist must reduce the dose to a patient-specific, volumetric dose for a liquid medicine; of course, they must work it correctly, too. ------------------------------------------------------------------------------ From: Paul Trusten <[email protected]> To: U.S. Metric Association <[email protected]> Sent: Mon, January 31, 2011 4:03:55 AM Subject: [USMA:49710] a non-metric U.S. can kill children The President The White House Washington, DC 29599 2011-01-31 Dear Mr. President, A few days ago, I wrote to you urging that the U.S. finally achieve its goal of changing over to the SI metric system of measurement for the economic and academic health of the nation. Sometimes, however, our country needs to change over to metric for health reasons, period. My subject line in this e-mail is no exaggeration. American children are often harmed, or even killed, because our citizens, along with our healthcare professionals, drag traditional units of measurement (such as the teaspoonful) from the society at large into the hospital or clinic. Too many times, we read of stories such as the one in the links below, where teaspoonsful and mililiters or milligrams get confused. Although the Institute for Safe Medication Practices reconnended in 2009 that only metric units be used in connection with prescriptions, the following continues to take place, and will continue to take place until we as a people use only one system of measurement (metric): http://www.theredheadedpharmacist.com/?p=2956 http://www.wrcbtv.com/Global/story.asp?S=13923416 We need your leadership to help us "go metric" and save American lives. SIncerely, Paul Trusten, R.Ph. , Vice President and Public Relations Director U.S. Metric Association, Inc. www.metric.org [email protected] +1(432)528-8824
ismpmetric.pdf
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