The Impact of a Pediatric Antibiotic Standard Dosing Table on Dosing Errors

Abstract

OBJECTIVES The goal of this study was to compare the rate of dosing errors for antibiotic orders in pediatric patients before and after the implementation of an antibiotic standard dosing table with precalculated dosage for different weight ranges at a tertiary care hospital. METHODS A retrospective study of 300 antibiotic prescriptions for pediatric patients in three different settings (ambulatory care, inpatient, and emergency department) at a tertiary care hospital assessed the appropriateness of antibiotic dosing. The need for an antibiotic dosing standardization policy was identified after finding that more than 30% of patients experienced a dose variation of ±10% of the recommended daily dose. An antibiotic dosing standardization policy was implemented with an antibiotic standard dosing table for different weight ranges, and a hospital wide-education program was conducted to increase awareness of this new practice and its benefits. Three months after implementation, a random sampling of 300 antibiotic prescriptions collected from the same settings as the pre-intervention period was evaluated for compliance with the new policy and its effect on the number of antibiotic dosing errors. RESULTS Six hundred prescriptions were included in this study (300 in the pre-implementation phase and 300 in the post-implementation phase). Patient characteristics were similar in both groups in terms of sex, age, and weight. Physician compliance with the antibiotic dosing standardization policy after its implementation was 62%. The dosing standardization policy reduced the rate of dosing errors from 34.3% to 5.06% (p=0.0001), and weight documentation on the antibiotic prescription improved from 65.8% to 85.7% (p=0.0001). CONCLUSIONS Implementation of an antibiotic dosing standardization policy significantly reduced the incidence of dosing errors in antibiotics prescribed for pediatric patients in our hospital.INDEx TERMS antibiotic dosing, dose rounding, dosing errors, dosing standardization, medication safety, pediatrics J Pediatr Pharmacol Ther 2013;18(3):220-226

Evaluation of the causes and cost impact of returned intravenous medications at a tertiary care hospital in Riyadh, Saudi Arabia

“…Inability to recycle has been found to be the result of two major factors namely, short stability of IV preparations and using unstandardized doses. Implementing dosing standardization and polices that guide the medication use process in the hospital setting have also been found to be important in minimizing medication errors and promoting medication safety and control [18].…”

Adult and Pediatric Antibiotic Prophylaxis during Vascular and IR Procedures: A Society of Interventional Radiology Practice Parameter Update Endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology

“…In adult patients, drug doses are standardized. However, in children, drugs are prescribed based on the patient's age, weight, body surface area, and/or clinical condition (21). For pediatric antibiotic regimens, doses are usually weight-based, and therefore careful calculation is required to ensure correct dosage.…”

“…Pediatric patients therefore are at a higher risk than adults for experiencing the effects of dosing errors; this may result in subtherapeutic antibiotic dosing causing treatment failure and the emergence of resistant organisms (22) or supratherapeutic dosing and toxicity. Many institutions performing pediatric interventional procedures have an antibiotic dosing standardization that minimizes the risk of calculation errors and reduces the time required for dose calculation by the prescriber (21). Appendix C (available online on the article's Supplemental Material page at www.jvir.…”

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“…Many studies to reduce PEs and AEs in hospitalized children have investigated the impact of a single intervention such as education or training . The results of those studies showed that none of the interventions were superior in terms of error reduction.…”

“…Many studies to reduce PEs and AEs in hospitalized children have investigated the impact of a single intervention such as education or training. [18][19][20][21][22][23][24][25][26][27][28][29][30] The results of those studies showed that none of the interventions were superior in terms of error reduction. The processes of prescribing and administration are complex because the causes of errors are multifactorial 8 and different conditions for behaviours are involved.…”