10mls, or Two 5ml spoonfuls/spoonsful ??

[DavidS]

Another day working for the shoe company, which I like, actually, apart from the airconditioning which dries my eyeballs out , but that's another story....

When I was in college I'm sure it was insisted on that 10mls tds on a script was turned into "Two 5ml spoonfuls three times a day" and not "10mls three times a day."

After a short row with a rather truculent techie who refused to change her label because "that's what the doctor wrote" (but that's another another story) I decided to look it up, but couldn't find any trace in the BNF, Drug tariff or Medicines & Ethics about it.

Did I imagine it?

What is being currently taught, to pharmacists and technicians?

[Nik]

We were taught the same at uni and we do the same in hospital - but I wonder at what quantity others decide to use ml instead ? For example carbocisteine 250mg/5ml, patients could be on 15ml bd or other stupid liquids where the amount consumed in one go equals half the bottle...

[GAZ]

IMHO the techie is wrong! If he/she wanted to label as per script then it would be labelled "10ml tds"...which would be stupid!!! If you (as RP??) would like it labelled as Two 5ml spoonfuls and the techie wants 10ml THEN why not reach a compromise = "Two 5ml spoonfuls (10ml)" - job done

[shan]

Well I was always told and followed that the quantity should always be in words (like ONE Tablet instead of 1 tablet) and liquids in the units of a spoonful ex ONE 5ml spoonful, TWO 5mls spoonful etc and even HALF a 5ml spoonful (2.5ml) so this way the dumbest of a person can understand how to take their medicine (many may not even know how much is 10mls when you give a spoon and say take 10mls) Now the actual issue is when the dose is in odd mls ex. 3.75 mls, 7.8mls, this is where you are supposed to supply a oral syringe and explain to the patient how much to use, so you mention the dose as "take/ give/ use 7.8mls using the oral syringe provided". Well, I have not seen any text anywhere in any reference source as to what to write on a label. But, as a responsible pharmacist, it is our duty to make the instructions as clear as possible for even a lay man understand. As fort he ACT, there are two ways I would make him/ her understand this fact 1. Explain the logic as above 2. Tell him/ her that as long as I am the responsible pharmacist the instructions would be as per the statement above, whether they like it or not.

Shan

[DavidS]

but I wonder at what quantity others decide to use ml instead ? .... where the amount consumed in one go equals half the bottle...

In those circumstances I would say 30ml using the measure provided, but actually I still prefer six 5ml spoonfuls, and tell them about using a measure. Memories of a mother trying to feed five spoonfuls of paracetamol to her toddler don't fade quickly.

Well I was always told and followed that the quantity should always be in words (like ONE Tablet instead of 1 tablet) and liquids in the units of a spoonful ex ONE 5ml spoonful, TWO 5mls spoonful etc and even HALF a 5ml spoonful (2.5ml) so this way the dumbest of a person can understand how to take their medicine (many may not even know how much is 10mls when you give a spoon and say take 10mls) Now the actual issue is when the dose is in odd mls ex. 3.75 mls, 7.8mls, this is where you are supposed to supply a oral syringe and explain to the patient how much to use, so you mention the dose as "take/ give/ use 7.8mls using the oral syringe provided". Well, I have not seen any text anywhere in any reference source as to what to write on a label. But, as a responsible pharmacist, it is our duty to make the instructions as clear as possible for even a lay man understand. As fort he ACT, there are two ways I would make him/ her understand this fact 1. Explain the logic as above 2. Tell him/ her that as long as I am the responsible pharmacist the instructions would be as per the statement above, whether they like it or not.

Shan

Agree in every particular. Thanks to Gaz also. Actually, Gaz, the next script was for amoxycillin 125mg tds which rather made the point, but by then she was off slamming doors elsewhere in the building.This technician wasn't an ACT, actually, afaik. I think they train them a bit better, and with any luck the really bolshy, truculent ones don't get through the course.

[tinx25388]

I generally convert to spoonfuls - mainly, because thats what SmartScript does when I enter 10ml.

We do have one Care Home that uses measuring cups instead of spoons, and insists we put it just in "mls" Otherwise, I would always convert to spoonfuls!

Also part of the training as a tech is that the Pharmacist is in charge, and what they say (within reason!) goes - so if I was asked to change it, I would do so.

On a side-issue: if you are working for the shoe company - how come you have air-con that works?!?!?

[orangiey]

In hospital any quantity over 10ml is labelled in total mls and if quanity is less as ONE or TWO spoonfuls....unless it's needing an oral syringe then the ml are used such as Give 2.5ml via the oral syringe THREE times a day. As a Tech who trained in the late 80s in hospital I find my standards as a Tech are higher than those who train in retail ie I always capitalise the quanity and frequency and also use ONE capsule to be taken ... or ONE tablet to be taken ....against the as such which helps in the checking process eg Ramipril caspules or tablets and I hate Take ONE DAILY!! Maybe things will improve with Technciain registaration as after all we are all equal now, wherever we trained?

[DavidS]

@tinx: thanks for the news about the aircon. There is still hope, then.

@orangiey I thought that "...to be taken" was frowned on now as being harder to understand than "Take ...... "
As far as capitalisation is concerned, I can remember when labels for external use were supposed to be in red and we had a selection of different shaped and textured bottles. I think that ETP is having a steadily degrading effect on the clarity of labelling.

But then, if the receptionists can understand it, perhaps were are being too fussy.

[LeftArm]

I remember when the labels had "The Tablets" and "The Lotion" printed on them and you had to write the dosage on with a quill (well a biro anyway).
They had to be moistened on the back to make the glue work so there was a special label licking device. :-)
I don't think that ETP has been the driver for change however.


Everything you ever wanted to know about safe dispensing labels except the answer to the original question.
Design for patient safety: a guide to the design of dispensed medicines

[Fleegle]

Another day working for the shoe company, which I like, actually, apart from the airconditioning which dries my eyeballs out , but that's another story....

When I was in college I'm sure it was insisted on that 10mls tds on a script was turned into "Two 5ml spoonfuls three times a day" and not "10mls three times a day."

After a short row with a rather truculent techie who refused to change her label because "that's what the doctor wrote" (but that's another another story) I decided to look it up, but couldn't find any trace in the BNF, Drug tariff or Medicines & Ethics about it.

Did I imagine it?

What is being currently taught, to pharmacists and technicians?

Agree totally on the 5ml spoonful conversion, but it doesn't work. I don't know what's being taught in schools these days, but I find 'give (or take)' a 10ml dose works better. You'd be surprised how many people don't actually know that 5 is half of 10 and 2 is two times 1. I once had a young mother who took the childs antibiotic herself, because the label said 'take' and not 'give' the dose. (Also had a guy who brought his betnovate ointment back to the shop to keep for him because the label stated 'Not to be taken')

Strange but true.

Fleeg.