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Are prescribed doses of medicine for children measurable ?

This study examines the measurability of prescribed doses of liquid medicine for children and explores the potential errors associated with immeasurable doses. The research highlights the need for standardized practices and further investigation in this area.

waltercjackson
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Are prescribed doses of medicine for children measurable ?

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  1. Are prescribed doses of medicine for children measurable? Morecroft CW,Liverpool John Moores University Gill A,Alder Hey Children’s NHS Foundation Hospital Trust Caldwell NA,Wirral University Teaching Hospital Foundation Trust Wood R,Liverpool John Moores University Crolla J,Liverpool John Moores University Antwi-Boasiako L,Liverpool John Moores University

  2. Are prescribed doses of medicine for children measurable?Objective • What proportion of prescribed doses of liquid medicine for children and neonates are measurable?

  3. Are prescribed doses of medicine for children measurable?Method • Liquid medications prescribed to paediatric/neonatal inpatients at two hospitals. • Five week period January/February 2011. • Name, strength and prescribed dose of drug, demographics, volume and whether dose measurable in single syringe.

  4. Are prescribed doses of medicine for children measurable?Results • 1599 doses for 431 patient records reviewed. • 196 doses (12.3%) immeasurable. • 29 (14.8%) within neonates, 58 in infants (25.6%), 81 in children (41.3%) and 28 in adolescents (14.3%).

  5. BNF category of immeasurable doses

  6. Examples of immeasurable doses

  7. Immeasurable doses and measuring device

  8. Are prescribed doses of medicine for children measurable?Discussion If prescribed dose cannot be measured, and an almost dose is given, is it a prescribing or administration error .... or not an error at all? Ideally measurability should be considered by prescriber or be reviewed by pharmacist prior to administering first dose. Pharmacists often endorse prescriptions with volume to be administered but this may introduce error.

  9. Are prescribed doses of medicine for children measurable?Discussion • Resolving problem complicated as concentrations of medicine vary widely and dose rounding needs to take account of graduations on syringe. Most people do not know graduations? • Some medicines are more likely to be immeasurable. • To make immeasurable dose measurable, by approximation, might have serious impact on patient for those drugs with narrow therapeutic index/window. What are the rules?

  10. Johnson et al. “Automated dose rounding recommendations for pediatric medications. Pediatrics 2011; 128: e422-428 Objective: establish best practice and create interoperable rounding knowledge base combining best practice and dose rounding information. Method: literature review and expert interview. Consensus about rounding tolerance through Delphi process. Results: 3 categories defined. A. meds rounded judiciously to retain intended effect eg furosemide. B. meds rounded with attention to potential unintended effect eg steroids. C. meds with narrow therapeutic effect and high risk of toxicity eg digoxin. Conclusion: integrate knowledge base into e-prescribing systems.

  11. Are prescribed doses of medicine for children measurable?Recommendation Further research required to explore measurability of doses of liquid medicine and relationship with those with narrow therapeutic window.

  12. Are prescribed doses of medicine for children measurable?Conclusion 1 in 8 prescribed doses of liquid medicine cannot be measured. We need to fix it!

  13. Oh bother! I get so mixed up. Did he say 2.34643mL or 6.43234mL?

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