Preventing medication errors in children, part 2

Despite the recommendations discussed in Part 1 (June 2008 issue of Contemporary Pediatrics), medical errors will continue unless a safer system is developed. It is the feeling of the authors that our health care system desperately needs to adopt a universal "standard" dosage system for children that eliminates the need for calculations of drug dosages and dilutions in both the inpatient and outpatient environments. Such a system will simplify drug dosing and administration, overcome language barriers, and drastically reduce the threat of "death by decimal point."

Presently there is very little standardization in pediatric dosing. Why? One explanation is that the prevalence of weight-based dosing necessitates individual drug calculations for each patient. Physicians enjoy the freedom to calculate an "exact" dose depending on the drug and clinical circumstance. The issue, however, is that each individually calculated drug order needs further calculations to accommodate dilution and other practical size-related issues. These calculations are both error prone and prolong the administrative process.

Existing dosing systems

At many children's hospitals across the country, "code sheets" are frequently used to help expedite care and reduce dosing errors during resuscitation efforts. Code sheets or code cards list common resuscitation meds by name and indication, the standard dose of medication based on the weight of the child (ie, a milligram per kilogram dose), and the concentration of the medication. More sophisticated sheets list the volume of medication that must be administered for children in different weight categories. While these are helpful, they are limited to a relatively small number of medications that may need to be administered to a child.

Technologies such as personal digital assistants and other computerized systems also allow access to drug doses. Using the weight of a patient, computerized systems calculate doses, and combined with bar coding technologies, can quickly assure that the medication being administered is indeed for the right patient. Known allergies and potential drug-to-drug interactions are simultaneously assessed. The use of these systems in acute resuscitations, however, has been somewhat limited, perhaps due to the time required to enter data at the bedside when other priorities may be more immediately pressing.