Nine common medication errors: How they happen and how to avoid them

Accidents happen - from children overdosing on medicine that has been left out to parents and caregivers giving children the wrong dose (or even taking it themselves). Then there are mistakes that we make without ever knowing.

The emergency room (ER) of a hospital is the place where casualties arrive to be treated for accidents.

The ER is also where parents first dock when a child has chugged a full bottle of syrup by accident.

Every month, MP Shah Hospital receives between three to four patients for emergencies related to accidental medicine overdose.

“About half of those cases lead to inpatient hospitalisation,” says Dr Jane Mate, a consultant paediatrician at the hospital. “This would mean that they are severe in nature.”

A recent incident at MP Shah saw an 18-month old admitted for overdosing.

According to Dr Mate, the toddler was under medication for fever and his mother had left a bottle of Calpol – a common painkiller syrup with a characteristic pink colour – open upon administering a dose.

“The boy took the bottle and drank it out,” Dr Mate says regarding the incident.

On realising what had happened, the mother rushed the baby to the hospital. It was a good call.

Such an overdose, the doctor notes, can be deadly. “It can cause acute liver damage because the syrup is predominantly broken down by the liver once in the body,” Dr Mate says.

Doctors define medicine as substances that can be used to treat but that can be poisonous to the body if not administered according to prescription.

There are two organs that are most affected by medicine: the liver and the kidney. Majority (about 95 per cent) of emergency cases involving medicine poisonings are related to overdosing, Dr Mate notes.

“The kidney, because it is responsible for excreting all toxins that enter the body,” Dr Mate says. The doctor says that some drugs, when overdosed, can lead to kidney failure.

The dangers for mishandling children’s medicine are vast. Anything can happen. And that is why it is important that parents pay extra attention to avoid some mistakes which have become common with handling of children’s medicines.

Today we share with you drug-related don’ts to avoid:

1. Leaving medicine within a child’s reach

Many medicines meant for children are carried in syrup – a sweet viscous fluid. Obviously, the idea is to make it easy for the children to consume the medicine.

While the sweetness solves one problem it creates another: children are likely to want to sip more of the medicine.

This is what happened in the MP Shah case. The boy was left with a bottle of medicine that was not properly closed. He opened it and emptied the sweetness into his mouth and down his gullet.

“Never leave your child – even for two seconds – with easy access to medicine,” Dr. Mate says.

This, by extension, means that medicine should be under lock and key at all times.

2. Frequency error

What does ‘three times a day’ mean? Is it breakfast, lunch and supper?

The three meal schedule has been the guiding principle for decades. This, Dr Mate says, came about because most medicines are administered ‘after meals’.

But this, she says, is not what ‘three times a day’ means. “In a day there are 24 hours. Split it into three it and it gives you eight hours. Three times means therefore means every eight hours,” she says.

How would this work if medicine is to be given after meals?

If the 8-hour interval does not conform to meals, the doctor explains that one can give the child a snack, say a cup of yoghurt, half an hour before giving the medicine.

She says: “’After meals’ medicine work best when the stomach has some food. Hence, regardless of meal scheduling, the child can be given some food (not necessarily a lot of food) 30 minutes to administering the drug.”

3. Overdosing past daily limit

Every paediatric medicine has a daily dosage limit. This is the maximum amount of medicine a child can be given within 24 hours.

Dr Mate says: “Let’s say for instance, that your child is prescribed paracetamol every four hours.

“In most cases there is usually a caveat: every four hours but not more than 4 times in 24 hours.

“Four hours go into 24 six times. But the instruction is that the medicine shouldn’t be administered more than four times. Hence, there is risk of a parent overdosing the child if they are not keen.

“If the paracetamol has been administered four times, and the baby still presents with a fever, the parent should head back to hospital to seek a doctor’s counsel for next course of action.”

4. Dosage by age and weight

Both of these parameters, Dr Mate says, are important and should be considered when administering medication.

When parents buy over-the-counter medicine – without prescription from a clinician – the practice is to administer based on age.

This, the doctor points out, could lead to erroneous dosage – either under dose or overdose.

The best metric to base dosage, says Dr Mate, is weight. “Two children who are age mates but weighing significantly apart cannot be given the same dosage,” she says. “The one who is heavy will get slightly more medicine than the one who weighs less.”

What about age? According to Dr Mate, age is important in dictating maximum dosage.

“The body of a child (however heavy that child is) is still not fully developed. Their immunity and organs cannot handle higher levels of medication.

“So, while we give medicine based on weight, the age matters in that for every medicine there is a maximum amount of dosage for every age group.”

5. Wrong instrumentation

Most (if not all) children’s medication come with measuring cups, syringe, or spoon – with calibration.

These are the measuring tools parents should use to administer medicine. It is therefore important to keep a few of them in the house.

Parents have a tendency of using spoons from kitchen cutlery – either due to preference or lacking a measuring instrument.

While conventional spoons might conform to dosage amount, Dr. Mate notes that they are not manufactured for that purpose and could therefore be erroneous hence the risk of under dosing or overdosing.

6. Over the counter drugs

Dr Christabel Khaemba is the head of medicines information and pharmacovigilance directorate at the Pharmacy and Poisons Board of Kenya.

She says that drugs can broadly be categorised as over-the-counter, pharmacy only, and prescription only medicines.

Of the three, the ones readily available to the public are over-the-counter (OTC). The other two can only be accessed when prescribed by a medical doctor or a pharmacist.

The danger with over-the-counter drugs (common drugs like painkillers) is that they are prone to abuse.

“When a child has a cough or a common cold they will go and buy over the counter drugs to administer,” Dr Mate says.

While legally parents can buy OTC drugs to give children, Dr Mate advises against the habit – for pediatric patients.

She says: “Many OTC drugs contain the same active ingredients. For instance, lots of cold syrups contain antihistamines and alcohol also found in other syrups.

“If you treat your child’s congestion with a multi-symptom product, then treat fever with a paracetamol syrup that has some of those ingredients, the baby gets double the amount of these ingredients.

“Hence the child becomes overdosed with the specific components of the medicine.”

Before giving your child OTC drugs, Dr Mate says, get a second opinion from a paeditrician.

7. Repeating dosage when the child vomits

What should you do when your child vomits after taking medicine?

This, Dr Mate says, is dependent on the length of time it took for the child to vomit post consuming the medicine.

“If the child vomits immediately after the medicine has been given then repeat the dosage,” she says. “If the child vomits 15 or so minutes (or later than that) after taking the medicine then do not repeat the dosage.”

Drugs, Dr Mate says, get absorbed into the body within 15 minutes. Hence the above directive.

8. Keeping residual medicine for later use

The temptation is for us to keep any ‘left over’ medicine for later use – especially with painkillers issued for fever.

This habit, Dr Mate says, is dangerous and counterproductive.

“All medicine that have been opened cannot be used past one month from the day it is opened date of expiry notwithstanding,” she says.

Once bottled medicine is opened and exposed to atmosphere (not forgetting human handling) lose integrity after about a month.

“They can be contaminated. And since syrups have sugar, which bacteria love, they go bad after a certain period of time.”

Any residual medicine, Dr Mate says, should therefore be discarded.

9. Store within right conditions

Some medicines, Dr Mate notes, come with specific storage instructions: ‘under 20°C’ or ‘away from sunlight’.

“It is upon the parent to make sure that these instructions are followed to the later.

“If not, the drugs will lose efficacy – their power to work against the illness. And therefore the baby won’t be getting treated,” the doctor says.

Sunlight, she notes, react with some medicines and change their chemical structure. While some medicines react and change and lose chemical integrity at certain temperatures.

However, she adds, drugs stored in the fridge can be put out of the fridge momentarily (to lose the cold) before being administered – for the child’s comfort.