Daniel W. Wheeler, PhD; Joseph J. Carter, MBChB; Louise J. Murray; Beverley A. Degnan, PhD; Colin P. Dunling, BSc; Raymond Salvador, PhD; David K. Menon, MD, PhD; Arun K. Gupta, PhD
Potential Financial Conflicts of Interest: None disclosed.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available to approved individuals through written agreements.
Requests for Single Reprints: Daniel W. Wheeler, PhD, Division of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom; e-mail, email@example.com.
Current Author Addresses: Drs. Wheeler, Carter, Degnan, Menon, and Gupta and Mr. Dunling: University Division of Anaesthesia and Department of Anaesthetics, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
Miss Murray: Simulation Centre, Addenbrooke's Hospital Postgraduate Centre, Box 111, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
Dr. Salvador: Benito Menni–Centre Assistencial en Salut Mental, Dr Pujadas 38, Sant Boi de Llobregat, 08830 Barcelona, Spain.
Author Contributions: Conception and design: D.W. Wheeler, B.A. Degnan.
Analysis and interpretation of data: D.W. Wheeler, B.A. Degnan, R. Salvador.
Drafting of the article: D.W. Wheeler.
Critical revision of the article for important intellectual content: D.W. Wheeler, J.J. Carter, L.J. Murray, B.A. Degnan, C.P. Dunling, R. Salvador, D.K. Menon, A.K. Gupta.
Final approval of the article: D.W. Wheeler, J.J. Carter, L.J. Murray, B.A. Degnan, C.P. Dunling, R. Salvador, D.K. Menon, A.K. Gupta.
Statistical expertise: R. Salvador, D.K. Menon
Obtaining of funding: D.W. Wheeler
Administrative, technical, or logistic support: J.J. Carter, L.J. Murray, B.A. Degnan, C.P. Dunling.
Collection and assembly of data: D.W. Wheeler, J.J. Carter, L.J. Murray, B.A. Degnan, C.P. Dunling.
Wheeler DW, Carter JJ, Murray LJ, Degnan BA, Dunling CP, Salvador R, et al. The Effect of Drug Concentration Expression on Epinephrine Dosing Errors: A Randomized Trial. Ann Intern Med. 2008;148:11-14. doi: 10.7326/0003-4819-148-1-200801010-00003
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Published: Ann Intern Med. 2008;148(1):11-14.
Clinical error and negligence are responsible for disabling injuries in about 1 in 25 hospital admissions (1). Most of these injuries are caused by adverse drug events, which prolong hospital stay, increase care costs, and nearly double a patient's risk for death (2, 3). About one third of adverse drug events occur during drug administration, when interception is unlikely (4). The confusion caused by expressing the concentrations of drug solutions in different ways is an important cause of dose errors (5–10). Converting among ratios, percentages, international units, mols, micrograms, and milligrams causes substantial difficulty, especially for less experienced physicians or those most removed from acute care. Epinephrine, lidocaine, heparin, and potassium chloride are frequently associated with drug error (11). It may be no coincidence that the strengths of these drug solutions are typically expressed in ratios, percentages, international units, and millimols, respectively.
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Emergency Medicine, Hospital Medicine, Prevention/Screening.
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