Pediatric Prehospital Medication Dosing Errors: A National Survey of Paramedics

Prehosp Emerg Care. 2017;21:185-191.

This survey of paramedics found that pediatric dosing errors in the prehospital period are common. Respondents used varied methods for estimating weight of pediatric patients in order to calculate drug doses, and they advocated for pediatric training and standardized weight estimation methods to reduce risks. These findings suggest several possible interventions to enhance pediatric medication safety in the prehospital setting.

| PubMed 28257249 | Author Search

Prescription Order Risk Factors for Pediatric Dosing Alerts

International Journal of Medical Informatics

http://www.sciencedirect.com/science/article/pii/S1386505614002202

A retrospective analysis of inpatient medication orders and dosing alerts at a large, academic, pediatric medical center. Pediatric orders had higher odds for an alert compared to adult orders. The alert rate was highest for immunosuppressive agents (> 50% alert rate), medications for neonates (6.7%), orders for rectal administration (9.5%), and orders for continuous infusion (7.9%). Orders for albuterol continuous aerosol and heparin injection solution had near-100% alert rates. Opioid alerts had among the lowest alert rates, at 7.4%. There was also a temporal analysis that indicated that January was

Stultz 2015 (Link) | PubMed 25466381 | Author Search

Computerized Dose Range Checking Using Hard and Soft Stop Alerts Reduces Prescribing Errors in a Pediatric Intensive Care Unit

This before-and-after study found that introduction of a tiered alert system for medication dosages in pediatric patients led to an increase in alerts, but also resulted in fewer overridden alerts and more medication order revisions. This work emphasizes the need to improve electronic medication alerts to make them more actionable and reduce alert fatigue. (Journal of Patient Safety)

Balasuriya 2014 (Link) | PubMed 25370855 | Author Search

Standard dose development for medications commonly used in the neonatal intensive care unit

Robinson CA, Siu A, Meyers R, Lee BH, Cash J

J Pediatr Pharmacol Ther 2014 Apr;19(2):118-26

PMID: 25024672

OBJECTIVES: To establish standardized, rounded doses of medications for neonates in the neonatal intensive care unit (NICU) through a multi-institutional peer-reviewed process.

METHODS: Pediatric faculty and pediatric pharmacy residents from the Ernest Mario School of Pharmacy (Piscataway, NJ) conducted a systematic review of rounded, weight-based medication information for neonatal patients from September 2010 to April 2011.
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Evaluating the accuracy of electronic pediatric drug dosing rules

Kirkendall ES, Spooner SA, Logan JR

J Am Med Inform Assoc 2014 Feb;21(e1):e43-9

PMID: 23813541

OBJECTIVE: To determine the accuracy of vendor-supplied dosing eRules for pediatric medication orders. Inaccurate or absent dosing rules can lead to high numbers of false alerts or undetected prescribing errors and may potentially compromise safety in this already vulnerable population. [Read more…]

Sensitivity and specificity of dosing alerts for dosing errors among hospitalized pediatric patients

Stultz JS, Porter K, Nahata MC

J Am Med Inform Assoc 2014 Feb;

PMID: 24496386

OBJECTIVES: To determine the sensitivity and specificity of a dosing alert system for dosing errors and to compare the sensitivity of a proprietary system with and without institutional customization at a pediatric hospital.

METHODS: A retrospective analysis of medication orders, orders causing dosing alerts, reported adverse drug events, and dosing errors during July, 2011 was conducted. Dosing errors with and without alerts were identified and the sensitivity of the system with and without customization was compared.

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