Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

Kuhn, Alexis; Saini, Surbhi; Stanek, Joseph; Dunn, Amy L.; Kumar, Riten

doi:10.1002/pbc.28872

Cited by 2 publications

(1 citation statement)

References 16 publications

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“…http://links.lww.com/PQ9/A568). 3–9,11–34 Medications were included in this document if they had high potential for serious patient harm if inappropriately dosed on an mg/kg basis in a patient with obesity and if they had frequent utilization at our institution. A pharmacist-led multidisciplinary task force reviewed the literature and decided which alternative weight (ideal body weight or adjusted body weight) would be most appropriate for each medication when dosed in patients with obesity.…”

Section: Methodsmentioning

confidence: 99%

A Quality Initiative to Improve Appropriate Medication Dosing in Pediatric Patients with Obesity

Cloyd,

Macedone,

Merandi

et al. 2024

Pediatric Quality &Amp; Safety

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Introduction: Emerging evidence supports the use of alternative dosing weights for medications in patients with obesity. Pediatric obesity presents a particular challenge because most medications are dosed based on patient weight. Additionally, building system-wide pediatric obesity safeguards is difficult due to pediatric obesity definitions of body mass index-percentile-for-age via the Center for Disease Control growth charts. We describe a quality initiative to increase appropriate medication dosing in inpatients with obesity. The specific aim was to increase appropriate dosing for 7 high-risk medications in inpatients with obesity ≥2 years old from 37% to >74% and to sustain for 1 year. Methods: The Institute for Healthcare Improvement model for improvement was used to plan interventions and track outcomes progress. Interventions included a literature review to establish internal dosing guidance, electronic health record (EHR) functionality to identify pediatric patients with obesity, a default selection for medication weight with an opt-out, and obtaining patient heights in the emergency department. Results: Appropriate dosing weight use in medication ordered for patients with obesity increased from 37% to 83.4% and was sustained above the goal of 74% for 12 months. Conclusions: Implementation of EHR-based clinical decision support has increased appropriate evidence-based dosing of medications in pediatric and adult inpatients with obesity. Future studies should investigate the clinical and safety implications of using alternative dosing weights in pediatric patients.

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Section: Methodsmentioning

confidence: 99%

A Quality Initiative to Improve Appropriate Medication Dosing in Pediatric Patients with Obesity

Cloyd,

Macedone,

Merandi

et al. 2024

Pediatric Quality &Amp; Safety

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Heparin

2021

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Major bleeding: 2 case reportsIn an observational cohort study involving 95 paediatric patients in a hospital in USA, two patients [ages and sexes not stated] were described, who developed major bleeding during anticoagulant therapy with heparin. Both the patients received heparin infusion [unfractionated heparin; dosages not stated] based on actual body weight without a dose cap, of whom one patient was obese. Both the patients received titrated doses of heparin for maintenance of therapeutic anti-FXa levels. However, both the patients developed major bleeding during anticoagulant therapy with heparin [duration of treatment to reaction onsets and outcomes not stated].Kuhn AK, et al. Unfractionated heparin using actual body weight without dose capping in obese pediatric patients-Subgroup analysis from an observational cohort study.

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Unfractionated heparin using actual body weight without dose capping in obese pediatric patients—Subgroup analysis from an observational cohort study

Cited by 2 publications

References 16 publications

A Quality Initiative to Improve Appropriate Medication Dosing in Pediatric Patients with Obesity

A Quality Initiative to Improve Appropriate Medication Dosing in Pediatric Patients with Obesity

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