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A pediatrician ordered ampicillin suspension (125 mg/5 ml) 1 teaspoon, q.i.d., to be given to his patient for 10 days. The pharmacy dispensed the 10-day supply is a 200-ml bottle. Eight days after the child started receiving the antibiotic, a nursing instructor on a pediatric rotation noticed that the bottle was only half empty, when 80% of the medication should have been given. Yet all doses were signed for on the medication administration record.
The instructor asked the nurses how they were administering the antibiotic. They showed her the colorful plastic teaspoons they'd obtained from the dietary department to administer oral liquids to children. When the instructor measured a spoon's capacity, she found it to be less than 3 ml. The child hadn't received his proper dose of 5 ml at any time during the 8 days.
The volumes of different teaspoons may vary by up to 100%, and even medication cups aren't always accurate. So make sure your drug administration equipment includes accurate measuring devices for oral liquids, or better yet, try to get the pharmacy to dispense medications in unit-dose form.
One idea might be to use a 5-ml syringe to administer a teaspoon of medication. But this practice could be more dangerous than an inaccurate measurement; someone could mistakenly attach a needle and inject the suspension.
A better idea would be to use a specially designed syringe that won't accommodate a needle. Ask your pharmacist to package liquid doses this way for children or about ordering these syringes for your unit. But be careful; even these devices have been used for injection when placed on the Luer-Lok receptor of an indwelling intravenous catheter.
One final note: Warn patients taking oral liquids at home about the volume variances of different teaspoons. Supply them with accurate measuring devices if they're available.