The effect of drug concentration expression on epinephrine dosing errors: a randomized trial.

Ann Intern Med 2008 Jan;148(1):11-4

Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.

Background: The expression of drug concentration as a ratio may cause dosing errors.

Objective: To examine the effect of ratio expressions on drug administration.

Design: Randomized, blinded, controlled study.

Setting: Simulation center in an urban hospital.

Participants: 28 physicians.

Intervention: Participants managed a simulated pediatric acute anaphylaxis scenario by using epinephrine ampules labeled with mass concentration (1 mg in 1 mL) or a ratio (1 mL of a 1:1000 solution).

Measurements: The amount of epinephrine given and the time taken to administer it.

Results: Compared with providers using ampules with mass concentration labels, those using ratio labels gave more epinephrine (adjusted mean dose, 213 microg above target [95% CI, 76.4 to 350.1 microg]; P = 0.003), and took longer to do so (adjusted mean delay, 91 seconds, [CI, 61.0 to 122.1 seconds]; P < or = 0.0001).

Limitations: Performance in simulated scenarios may not reflect clinical practice. In reality, ampule labels provide both expressions of concentration.

Conclusion: The use of ratios to express drug concentration may be a source of drug administration error. Patient safety might be improved by expressing drug concentrations exclusively as mass concentration.

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Source
http://dx.doi.org/10.7326/0003-4819-148-1-200801010-00003DOI Listing
January 2008

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