Safe Medication Practices

by Kala Rorbaugh with contributions by Jeni Burgess, Kelly Steidl and Margaret Anderson of Upstate Golisano Children’s Hosptial Peds Pharmacy Service

A sick child can put quite a bit of stress on a family and the added stress of several medicines creates an opportunity for medication errors to occur.  A medication error is an error that can happen at any point in the treatment pathway, starting when a clinician prescribes a medicine and ends when the patient receives the medicine.  Certain patients are at a higher risk for medication errors, including children, elderly patients, and those who take more than three medicines.  Knowing how to safely store, administer, and dispose of your child’s medicines can help prevent medication errors. 

Don’t Store Medicines in the Medicine Cabinet?

Medicines are often sensitive to changes in things like temperature, humidity, and light to name a few.  If a medicine is not stored in the right place it may make the medicine not work correctly.  It is important to check the labeling of a medicine for directions on how to store it properly.  If the label is unclear your pharmacist would be more than happy to help you. 

While the medicine cabinet’s name would suggest it would be a great place to store medicines, it actually is not!  The humidity in the bathroom from hot showers and baths can actually alter the medicine.  A cabinet in a kitchen or a hallway closet may be preferred if the temperature changes less often.  Some medicines need to be kept in the refrigerator; place these medicines in a safe place inside the refrigerator so they cannot be easily confused as a treat to children who are able to open the door.

 It is important to monitor the expiration date on a medicine.  While it may seem like a good idea to keep the leftover antibiotic “just in case,” it can be dangerous to take an expired medicine or to attempt to treat something with the wrong medicine

 Lastly, all medications should be kept out the reach of children!   Tell anyone at a house your children may be staying at to please do the same, Grandma and Grandpa may have some medications that can be potentially dangerous to children.  Remember to keep your meds high and dry and closed up tight!  

Not All Spoons Are Created Equal!

Administration of a medicine involves several pieces: giving the right amount, of the right medicine, at the right time, by the right route, to the right patient.  The best way to do this is to create a Medication Administration Record or MAR for short.  This is a schedule for medicines and it will say what amount of what medicine to give at what time by which route.  Once the medicine is given, the spot on the MAR can be marked as complete.  There is an example at the end of this section.

The Right Amount

There are usually liquid preparations available for medicines that children take.  The label from the pharmacy will usually say how many milliliters or mLs to administer.  Never use a household spoon to measure how much medicine to give, they vary in size from house to house and you could end up giving your child either way too much, or way too little of their medication.  The best things are oral syringes and medicine cups that can be used to appropriately measure the medicine.  Syringes are more accurate and give you more control when administering medicines to a squirmy child than medicine cups do, but older children may prefer the cup over the syringe.  These are usually for sale at the pharmacy and sometimes if you ask the pharmacist they can just give you one!  Your pharmacist can also show you how to use the syringe correctly to make sure you get the right amount of medicine.

 The Right Medicine

When a child is taking several different medicines it is important to read the labels closely before giving a medicine.  Bleary-eyed parents have been known to grab the wrong medication when their child gets sick in the middle of the night so use caution!  Sometimes pharmacies will pour liquid medicines into amber-colored bottles that protect the drug from light; however they all look the same and can put you at risk for medication errors!  You can always use a marker to mark the lid to look different or put stickers on the bottle to help you distinguish medicines from one another.

The Right Time

Medicines can be given once a day, twice a day or more and many of them are different. So it is important to know how many times a day a medicine is to be given. Using the MAR from the example below is a great way to ensure that you are giving the medicine at the right time.  It is also a great way to make sure that you don’t give the same medicine twice by accident and helps you remember that you actually DID give the medication.  You may also wish to keep a medicine box that allows you to keep all of the tablets and capsules for the day in one handy place.

The Right Route

Before giving a medicine read the label and make sure you are certain where the medicine is going.  For example, is this a liquid medicine to be given by mouth? Is this a suppository to be given rectally?  Or is this a topical medicine to be applied to the skin?  If you are ever unsure about how or where to administer a medicine, your doctor, nurse, or pharmacist should be able to help you.  Also, whenever a new medicine is prescribed you should ask your doctor, nurse, or pharmacist how you should give the medicine.

The Right Patient

Sometimes more than one family member is sick, ensuring that you are about to give a medicine to the right patient is important.  If a younger, smaller sibling gets the older, bigger sibling’s medicine it could result in an overdose and possible harm.  Getting the child involved in their own care can help, asking questions like, “Are you Jimmy?” before giving a medicine can help prevent giving the wrong patient the wrong medicine.  Use these suggests for  your child might sound like this story. Jimmy has an ear infection that is being treated with amoxicillin two times daily.  To make sure that he is getting his treatment safely his mom creates a MAR.  Mom notices that it is 8:00AM and the MAR says it is time to give Jimmy his amoxicillin.  First, she pulls the amoxicillin out of the refrigerator.  She knows it is the amoxicillin because she drew a purple dot on the top of the lid and she read the label that says, “amoxicillin 10mL by mouth twice daily.” Next, Mom uses an oral syringe to draw up 10mL of amoxicillin out of the bottle and then she double checks the label and the syringe to make sure she has drawn up the correct amount.  Next, she asks, “Are you Jimmy?” Jimmy laughs and says, “Yes Mommy! I’m Jimmy!” Now that Mom knows she has the right dose of the right medicine for the right patient at the right time, she double checks that this medicine is given by mouth and asks Jimmy to open wide.  Finally, so that she and dad both know that Jimmy got his dose at 8:00AM she marks an “X” in the column for 8:00AM. 

Figure 1: MAR Example



Amoxicillin 10mL by




Following the five rights before giving your child a medicine can help you ensure the safety of your child!





Medication Disposal

What happens when your child has finished the prescription but there is still medicine left?  What happens if a dose is changed and there is left over, expired medicine?  What happens to that medicine?  Leftover medicine should never be kept “just in case”.

Medicine that comes as pills or tablets should never be just thrown into the trash without first making the medicine undesirable to anyone who may stumble upon the trash.  This can be done by mixing the pills or tablets with used coffee grounds or kitty litter.  This is also an option for small amounts of liquid medication (just make sure it does not get too soupy).

Medicine that comes as a patch should always be place inside something before throwing it into the trash.  It can be put inside a laundry detergent bottle or something similar.  Again, our goal is to make it difficult to accidentally obtain.

Some medicines can be flushed down the toilet, a list of these medicines is available on the FDA website, an excellent sources of information on the disposal of medications.

The last option, and the safest option, is to check with your local pharmacy and police station.  Sometimes these locations have Drug Take-Back Events.  Check you local paper’s webpage for dates and locations.

Before throwing out any empty bottles or other medicine packaging make sure to scratch our or blacken with a marker any patient information like name, date of birth, address, medicine name, and doctor so that no one else can access the information. Proper disposal of medicines can help keep not just your child, but other children and pets safe!





 (Really great disposal website)



Posted in Peds to Parents | Comments Off

Fun in the Sun – Sun Safety

By Kala R. Rorabaugh PharmD Pediatric Pharmacy Resident

Winter is finally over and it is time to go out to enjoy the sunshine!  But before you reach for those flip flops and beach ball you should make sure you and your children are protected against the harmful rays of the sun


UV or ultraviolet rays are the harmful rays of light that cause skin irritations like sunburn and skin cancer.  Fortunately, it is easy to protect yourself from these rays.  Sunscreen is the easiest way to protect your skin.  It is important to buy sunscreen that is at least SPF 30, but don’t be fooled!  An SPF greater than 50 does not mean better protection, stick to sunscreens with an SPF of 30-50.  Also make sure your sunscreen says “broad spectrum”, this means it protects against both UVA and UVB light.  It is also useful to get water resistant sunscreen so skin is still protected in the pool, lake, or ocean.  This information is usually available right on the front label of the sunscreen.  Most adults need about one ounce of sunscreen to cover their exposed skin, make sure you are applying enough sunscreen on your kids.  And don’t forget their face, neck, and ears!  There is lip balm with SPF protection as well.

  Sunscreen should be applied heavily approximately 15 minutes prior to sun exposure and repeated every 2 hours.  Apply more often if the skin becomes wet such as in swimming, vigorous activity or excessive sweating.

Keep infants under 6 months out of direct sunlight.  If shade is not an option, consult your doctor about using sunscreen.  The American Academy of Pediatrics recommends using small amounts of zinc or titanium based sunscreen as a last resort for infants.

Sunglasses and hats are not just great fashion accessories!  They’re also great ways to protect yourself from the sun.  Sunglasses protect the UVA and UVB rays from damaging eyes.  Hats help to protect any area shaded by the outline of the hat, for example a big sombrero will protect more than a baseball cap, but both are important for shielding your face from the sun!

When playing outside it is important to drink lot of water.  Children can easily become dehydrated while playing in the hot sun, even while swimming!  It is also important to avoid being out in the sun during the peak hours of sunlight, usually 10AM to 3PM, when the harmful rays are the most exposed.  If you must be outside, try to stay in a shaded area.

Even on a cloudy day the dangerous rays can cause skin damage, so even if it doesn’t look sunny you should still use sunscreen, wear sunglasses and hats, drink plenty of water, and keep out of the sun.  Practicing these sun safety tips can help you enjoy summer safely!


Helpful Websites:

Posted in Peds to Parents | Comments Off

Let’s Not Meet By Accident during 100 Deadliest Days for Teen Drivers

By Kim Nasby, Upstate Trauma Center’s injury prevention coordinator and Let’s Not Meet By Accident instructor And Arielle Spears Marketing intern

 The Let’s Not Meet By Accident program of Upstate Medical University’s Trauma Center is offering easy tips for teen drivers during what the AAA Foundation for Traffic Safety deemed the “100 Deadliest Days for Teens.”

Upstate’s tips include how teen passengers can also help teen drivers stay focused on the road as well as tips for parents.

Despite progress in car safety regulations and new technology, motor vehicle accidents remain the leading cause of death for drivers ages 15 to 19. We at Upstate want to ensure that teens, their parents and the other drivers are properly prepared for the coming months, as well as encourage everyone to start practicing safe habits every day.

Tips for teen drivers and their teen passengers :

The most common distractions for teen drivers include cell phone use and texting, driving under influence of alcohol/drugs, talking with passengers, and the car radio.

Avoid distractions by:

Turning your cell phone off while driving. If not possible, put the phone on safe mode or download one of the many apps that prevents phone use while driving. Some apps offer settings that automatically reply to text messages. Passengers can hold the teen driver’s phone and respond to calls or texts for them. If the cell phone must be used by the driver, pull off the road at a safe distance before using the phone.

Have a back-up plan to avoid driving, or riding with someone under the influence of alcohol or drugs. Underage drinking and/or drug use while driving is illegal, dangerous and is proven to be deadly. Teen passengers should refuse to ride in a car with a teen driver who is under the influence. Remember, parents or other caregivers would much prefer a phone call for a pick up than a teen driving under the influence of drugs.

Limiting your vehicle to one passenger. Also, there is plenty of time to socialize after the ride, so teen passengers should reduce conversation and movement while on the road with teen drivers. Also, respect the teen driver and do not encourage negative behavior, such as speeding.

Finding your preferred radio station or playlist before you start the car and sticking with it until you reach your destination. Keep music at a low level and save the dancing for home.

Review maps and directions before leaving for an unfamiliar destination. GPSs should be placed in appropriate places that do not obstruct the driver’s view. If a GPS or map needs to be consulted, pull over at a safe distance. Teen drivers and teen passengers should also prepare for travel by checking the weather each day.

Keeping sunglasses in the car. The sun may also be an outside distraction for teen drivers. When buying sunglasses teens should opt for sunglasses labeled ‘UV 40′ or polarized lenses, to reduce glare from reflective surfaces like glass or polished metal.

Remember, all drivers, not only teens, should signal when changing lanes, wear a seatbelt, turn on headlights at night and during bad weather and always obey the speed limit. It takes only seconds to lose control of the car so don’t feel pressured by the flow of traffic to speed. Maintain a larger buffer zone with faster speeds.

Teen passengers should politely remind teen drivers to adhere to traffic rules if violated. Also, be on the lookout for pedestrians who may be difficult to see, especially at night and during bad weather.

Parents can also be of vital importance when protecting teen drivers and passenger.

Parents can:

Lead by example. Don’t text and drive, make sure all occupants in the car have their seat belt on and follow traffic laws.

Look into apps that monitor a teen’s texting and phone calls while they are driving.

Explain the dangers of driving under the influence and assure teen drivers, as well as teen passengers, that driving impaired is intolerable.

Consider a no passenger policy for their teen drivers until the teens have had more experience driving.

Stay informed on tips for safe driving for teens and review the information with their teen driver or teen passenger.

Let’s Not Meet By Accident is a free interactive injury prevention program designed by Trauma Services at Upstate Medical University to enlighten young drivers about the harsh realities of bad decision making behind the wheel. The program is offered once a month for up to 150 students from various schools throughout Central New York. The program services more than forty area high schools.

For more information, contact Let’s Not Meet By Accident at 315-464-4779


Posted in Peds to Parents | Comments Off

LEON Day features Upstate specialists aimed at keeping kids safe

By Elle Spears

Upstate is inviting kids and families to a free giant holiday party June 25 at Onondaga Lake Park in Liverpool.  It’s called LEON Day (that’s NOEL spelled backwards) and celebrates the half-way mark to the December holidays, the end of school and a kickoff to summer fun. The event takes place from 5 to 10 p.m.

“We at Upstate are taking this opportunity to educate families about summer injury prevention,” said Tamer Ahmed, M.D., medical director of Upstate Golisano Children’s Hospital’s Pediatric Trauma Program. “In the summer, parents and children are more active, which increases the risk of injuries. We want to ensure that everyone is safe and well prepared for the coming months, as well as highlight the outstanding child-focused groups at Upstate and in our community.”

Upstate will distribute 1,000 free children’s helmets that will be fitted by the Upstate’s Pediatric Trauma team, and provide summer tips to parents on ways to keep their children safe. Other health information on topics ranging from proper sleep hygiene to the warning signs of diabetes will be available. Upstate will also oversee a special “hometown hero” section where medical helicopters, fire trucks, police cars and more will be on display.

Other highlights include: a balloon walk, where children can explore the inside of an inflated hot air balloon, bounce houses, human foosball, a dunk tank, face painting, photo booths, magicians and more.

The event will conclude with the dropping of an Orange ball signifying the halfway point to Dec. 25, followed by fireworks. Various displays from Lights on the Lake will be set up and Lights on the Lake holiday characters will interact with children at the festival.

A special feature of the event is a concert by the Kidz Bop, the national singing sensation that has kids and parents alike dancing and singing along to today’s hit music.

Posted in Peds to Parents | Comments Off

Don’t Believe Everything You Read!

Part One : Why You Should Be a Skeptical Reader?

By Amy E. Caruso Brown, MD, MSc, MSCS

This is the first entry in a new occasional series, Don’t Believe Everything You Read!, that will help families read reports about child health and wellness more critically and better understand the science and research methods behind claims that appear in the popular news media.

 If you’ve glanced at a newspaper or turned on the evening news in the last few months, you’ve probably heard statements like these:

“No correlation between time spent with mom and overall success, study says”

“Toddler sleep problems tied to behavior issues later”

“Breastfeeding May Cut Breast Cancer Recurrence Risk”

“Bleach could be making your kids sick with respiratory infections”   In fact, Lee Livermore,Public Education Coordinator, Upstate New York Poison Center, wrote about that last one on this blog a few weeks ago.)

After reading these headlines, you’ve probably also contemplated whether you should be making changes in your own life.  You might have rushed home and swapped out all your plastic cups and bottles for BPA-free glass and metal containers, or maybe you just spent the drive home after work feeling guilty for not having sleep-trained your one-year-old yet.

Confession: I’m writing this as I drink my fourth cup of coffee today, a quantity I adopted as a regular habit after reading the torrent of journal articles – and, yes, newspaper headlines – about the health benefits of coffee. We are all – doctors, nurses, psychologists, scientists, and others – just as eager as anyone not working in science and medicine to discover practical ways to improve our health and well-being.

But as a physician-researcher (I specialize in taking care of children with cancer, many of whom are enrolled on clinical trials, and in bioethics), what stands out to me is how confidently journalists and reporters, at even nationally renowned publications, repeat these statements. If you haven’t read a medical journal lately, you might be surprised to learn that the researchers themselves are almost never so confident in the original scientific papers. In fact, the “Discussion” section of most research papers – the section where the authors explain what they think the study proved and why anyone would care – almost always has a paragraph or two on the limitations of the study. Simply put, these are “reasons you shouldn’t completely trust what we say.” These can be related to how the study was set up in the first place, how it was conducted, or how the data was analyzed. Very often, the researchers make a tentative conclusion or recommendation but then add that they also think another study needs to be done before they can be certain of that conclusion.

Over the course of this series, we’ll talk a lot more about the idea “limitations” in research, because those “limitations” often disappear when medical research is translated into national news. We’ll use current headlines related to hot topics in child health to help you understand the science and medicine behind the headlines.

We’ll answer questions like these:

  • Who decides what research gets done and what questions get asked?
  • What kinds of questions can research studies answer? Why can’t we answer everything we want to know?
  • How does research happen, and how long does it take to complete a research study and publish the results?
  • What’s the difference between the data or results of the study and the conclusions of the study?
  • What are some of the problems – practical, scientific, ethical – that doctors and scientists run into when designing research studies?
  • Who pays for medical research?
  • How many people are involved in a research study and what are their roles?
  • How are people or patients recruited to enroll in research?
  • Where can you find more information about participating in research studies?
  • Where can you find original research publications to read yourself?
  • How should you read an original research paper? (hint: not from beginning to end!)
  • When should you be especially skeptical of a research claim?

Author Biography: Amy Caruso Brown is an assistant professor of bioethics and humanities and pediatrics at SUNY Upstate Medical University. Her research interests include the teaching of ethics and professionalism in medical education, the impact of social media on medical practice, provider-family communication, and medical decision making.


Posted in Peds to Parents | Comments Off