The American Pharmacists Association (APhA) House of Delegates voted to adopt new policy on the labeling and measurement of oral liquid medications at the recently completed APhA Annual Meeting in Baltimore Maryland. More than 300 delegates voted on the policy, which would support moving away from outdated dosing cups and teaspoons in favor of oral syringes and cups that measure only in the metric system (milliliter –mL) as the standard for prescribing and measuring all oral liquid medications.

Numerous and sometimes fatal events have occurred as a result of confusion from not having unified measuring standards. Multiple national organizations have been calling for the adoption of the metric system in an effort to cut down on dosing and measurement confusion.

As a collaborating organization with the Center for Disease Control and Prevention (CDC) on PROTECT, an initiative to address the rise in emergency room visits due to over-the-counter (OTC) and prescription medication overdoses in children, APhA’s new policy reiterates the profession’s position on this important public health issue. The PROTECT initiative focuses on promoting safe medication packing with clearer dosing measures and labeling to ensure ease of administration by caregivers and increased education for parents and caregivers about proper use and administration of OTC medications. Pharmacists, and other members of the healthcare team, public health, parents and caregivers are committed to reducing the risk of medication overdosing in children.

The policy adopted by the APhA House of Delegates is as follows:

Labeling and Measurement of Oral Liquid Medications

1. APhA supports the use of the milliliter (mL) as the standard unit of measure for oral liquid medications.
2.  APhA encourages the mandatory use of leading zeros before the decimal point for amounts of less than one on prescription-container labels for oral liquid medications.
3. APhA discourages the use of trailing zeros after the decimal point for amounts greater than one on prescription-container labels for oral liquid medications.
4. APhA supports access to and universal availability of dosing devices with numeric graduations that correspond to the unit of measure that is on the container’s label for oral liquid medications.

Data from the National Electronic Injury Surveillance System-Cooperative Adverse Event Surveillance System (NEISS-CADES) project estimated that each year in the United States:

• Over 70,000 emergency department (ED) visits result from unintentional medication overdoses among children under the age of 18;
• One out of every 151 two-year-olds is treated in an ED for an unintentional medication overdose;
• Over 80% of ED visits among children under the age of 12 are due to unsupervised children taking medications on their own and 10% of ED visits in this age group are due to medication errors;
• OTC medications are involved in about one-third of ED visits among children under the age of 12