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Rapid Responses: Rapid Responses published:
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Juniors need more training
- DAVID G SAMUEL (29 June 2009)
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Preventing medication errors in children
- George W Rylance, Shama M Wagle (14 July 2009)
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DAVID G SAMUEL, F1 Paediatrics Prince Charles Hospital, Merthyr Tydfil CF47 9TG
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As an F1 doctor who has previously only worked within adult settings, prescribing for children was a daunting experience. Having to constantly rely on calculators to ensure correct dosages was time consuming, and rightly so but aloso unnerving as you were constantly wondering had you made an error. Coupled to this seems to be the trend that paediatric prescribing is not covered in undergraduate training, and that prescribing by weight hardly every gets mentioned in lectures. I also find the cBNF confusing in that both age AND weight related doses are given. What whould be used? Some hospitals have weight related presribing only policies, others age related, others use both. Confusion reigns and may be the reason for the high number of errors in childhood prescribing. I feel that greater paediatric friendly online resources for juniors coupled with a greater emphasis on paediatric prescribing amongst undergraduates may help reverse these current trends. Competing interests: None declared |
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George W Rylance, Chairman, Paediatric Formulary Committee, BNF for Children BNF for Children, Royal Pharmaceutical Society of Great Britain, 1 Lambeth High Street, London, Shama M Wagle
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The high rate of medication errors reported in children is concerning, although the majority result in ‘no harm’ or ‘low harm’.[1] Doses in BNFC are standardised according to weight, body-surface area, or age, and reflect the available evidence and clinical experience of their safety and efficacy. Although guidance was issued recently on selecting doses safely from BNFC [2], this is only one part of the process in ensuring children receive the right doses. The most common error involves administration of an incorrect dose or strength of medication.[1] Errors can occur when multiplying a dose by the child’s body-weight, converting from one metric unit to another, selecting a diluent, and calculating infusion rates or the volume of preparation to administer. A key contributing factor is the need to use tiny quantities of drugs from preparations intended for adults. Healthcare professionals must be proficient in basic mathematics, using relevant information from BNFC, and issuing safe prescriptions. They must beware of the common pitfalls and understand how to prevent them before prescribing, dispensing, or administering medicines to children. Undergraduate training on prescribing is less than desired, consequently the foundations for postgraduate training may be suboptimal and must be addressed. Integration of BNFC knowledge into decision support systems and paediatric dose calculators will also help to reduce errors. Recognising that medication errors occur commonly in neonates, BNFC 2009 includes a new Appendix on intravenous infusions in neonatal intensive care. We plan to expand this Appendix and review information on drugs that are involved in errors. 1. Review of patient safety for children and young people: NPSA 2009 2. BNF & BNFC e-newsletter, July 2008; accessed on http://bnfc.org/bnfc/bnfcextra/current/450066.htm Competing interests: None declared |
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