Liquid medication dosing errors in children: role of provider counseling strategies

Acad Pediatr. May-Jun 2014;14(3):262-70. doi: 10.1016/j.acap.2014.01.003.


Objective: To examine the degree to which recommended provider counseling strategies, including advanced communication techniques and dosing instrument provision, are associated with reductions in parent liquid medication dosing errors.

Methods: Cross-sectional analysis of baseline data on provider communication and dosing instrument provision from a study of a health literacy intervention to reduce medication errors. Parents whose children (<9 years) were seen in 2 urban public hospital pediatric emergency departments (EDs) and were prescribed daily dose liquid medications self-reported whether they received counseling about their child's medication, including advanced strategies (teachback, drawings/pictures, demonstration, showback) and receipt of a dosing instrument. The primary dependent variable was observed dosing error (>20% deviation from prescribed). Multivariate logistic regression analyses were performed, controlling for parent age, language, country, ethnicity, socioeconomic status, education, health literacy (Short Test of Functional Health Literacy in Adults); child age, chronic disease status; and site.

Results: Of 287 parents, 41.1% made dosing errors. Advanced counseling and instrument provision in the ED were reported by 33.1% and 19.2%, respectively; 15.0% reported both. Advanced counseling and instrument provision in the ED were associated with decreased errors (30.5 vs. 46.4%, P = .01; 21.8 vs. 45.7%, P = .001). In adjusted analyses, ED advanced counseling in combination with instrument provision was associated with a decreased odds of error compared to receiving neither (adjusted odds ratio 0.3; 95% confidence interval 0.1-0.7); advanced counseling alone and instrument alone were not significantly associated with odds of error.

Conclusions: Provider use of advanced counseling strategies and dosing instrument provision may be especially effective in reducing errors when used together.

Keywords: adherence; ambulatory care; health literacy; medication error; parents; patient communication; patient education.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Administration, Oral
  • Adult
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Dosage Forms
  • Emergency Service, Hospital
  • Equipment and Supplies
  • Female
  • Health Literacy*
  • Humans
  • Infant
  • Interrupted Time Series Analysis
  • Male
  • Medication Errors / prevention & control*
  • Parents / education*
  • Patient Education as Topic / methods*
  • Young Adult


  • Dosage Forms