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

Area of Science:

• Pharmacology and Drug Administration
• Patient Safety Research
• Medical Simulation

Background:

• Drug concentration expressions can be ambiguous, potentially leading to medication dosing errors.
• The use of ratio expressions (e.g., 1:1000) is a common practice in labeling certain medications.

Purpose of the Study:

• To investigate the impact of expressing drug concentrations as ratios versus mass concentration on drug administration accuracy.
• To evaluate potential medication errors associated with ratio-based drug labeling.

Main Methods:

• A randomized, blinded, controlled study was conducted in a simulated hospital setting.
• Twenty-eight physicians participated, managing a simulated pediatric acute anaphylaxis scenario.
• Participants administered epinephrine using ampules labeled with either mass concentration (1 mg/mL) or ratio (1:1000) formats.

Main Results:

• Physicians using ratio labels administered significantly more epinephrine than the target dose (adjusted mean dose, 213 mcg above target; P = 0.003).
• Administration time was also significantly longer for those using ratio labels (adjusted mean delay, 91 seconds; P < 0.0001).

Conclusions:

• Ratio expressions for drug concentration can be a significant source of medication administration errors.
• Enhancing patient safety may be achieved by exclusively using mass concentration formats for drug labeling.