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Administering oral medication to children – comparing the accuracy of parents with paediatric nurses
  1. VL Beckett1,
  2. LD Tyson1,
  3. N Gooding2,
  4. AW Kelsall2
  1. 1School of Clinical Medicine, University of Cambridge and Addenbrooke's Hospital, Cambridge, UK
  2. 2Neonatal Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK

Abstract

Aims Several devices are available to measure liquid medication in the home and hospital. Our study aimed to determine which measuring device was the most accurate amongst paediatric nursing staff and to compare measuring accuracy of nurses with caregivers.

Method Nurses completed a questionnaire detailing demographics and preference of medication devices. To ascertain device accuracy and the variance of volumes administered, nursing staff were asked to measure 5.0 mL of 120 mg/5 mL paracetamol suspension using a 5.0 mL dosing cup, 5.0 mL calibrated spoon and 5.0 mL oral syringe. Samples were weighed then converted into mLs (conversion rate=1.09 g/mL, Orbis Pharmaceuticals). The accuracy of nursing staff was compared with 277 caregivers using data obtained from our prior study.1

Results We recruited 103 paediatric nurses aged 21-60 years, trained for a mean of 9.5 years (3 months-40 years). Every participant considered the syringe most accurate. The mean volume measured using the dosing cup was 5.11 mL (95% CI 5.03-5.20 mL), 5.33 mL (95% CI 5.21-5.45 mL) using the calibrated spoon and 5.15 mL (95% CI 5.13-5.17 mL) with the oral syringe. There were significant differences from the 5 mL volume using all three devices (single sample t-test, p<0.01 for all comparisons). The variance of volumes measured with an oral syringe was significantly smaller compared to the calibrated spoon (Pitman's test; Rho=0.955, p<0.0001) and dosing cup (Pitman's test; Rho=0.900, p<0.0001). Furthermore, the variance of volumes measured with the dosing cup was significantly smaller than the calibrated spoon (Pitman's test; Rho= −0.299, p<0.0022). Nurses using an oral syringe produced significantly fewer variations in measurements compared to caregivers (98% parents) using a metal, calibrated spoon or oral syringe (F test, p<0.0001). Caregivers using an oral syringe were significantly more accurate than nurses using a dosing cup or calibrated spoon (F test, p<0.001).

Conclusions Nursing staff like caregivers measured medication most accurately using an oral syringe, displaying the smallest variance. The calibrated spoon was the least accurate with the widest variance. Nurses were significantly more accurate than caregivers when measuring medication with all devices. We recommend the oral syringe for measuring and administering paediatric medication in the home and hospital environment. Nurses should be encouraged to teach parents how to administer medication accurately.

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