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!
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. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/EnsuringSafeUseofMedicine/SafeDisposalofMedicines/ucm186187.htm
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!