Letters Dosage errors in paediatrics

Response from BNF for Children

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2926 (Published 21 July 2009) Cite this as: BMJ 2009;339:b2926
  1. George Rylance, chairman, Paediatric Formulary Committee1,
  2. Shama Wagle, assistant editor1
  1. 1BNF for Children, Royal Pharmaceutical Society of Great Britain, London SE1 7JN
  1. bnfc{at}bnf.org

    The high rate of medication errors reported in children is concerning,1 although the majority result in “no harm” or ”low harm.”2

    Doses in the BNF for Children (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,3 this is only one part of the process in ensuring children receive the right doses.

    The most common error entails administration of an incorrect dose or strength of drug.2 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 in 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 implicated in errors.


    Cite this as: BMJ 2009;339:b2926


    • Competing interests: None declared.


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