ASHP 08: Safety strategies for pediatric medicines concern all pharmacists

December 7, 2008

According to Stuart Levine, PharmD, an informatics specialist with the Institute for Safe Medication Practices (ISMP) in Horsham, Pennsylvania, although a hospital may not have a defined pediatric program, every hospital provides pediatric care. "If a child comes into your ER because of a car wreck, for example, you will be treating that child," Dr. Levine said.

According to Stuart Levine, PharmD, an informatics specialistwith the Institute for Safe Medication Practices (ISMP) inHorsham, Pennsylvania, although a hospital may not have a definedpediatric program, every hospital provides pediatric care. "If achild comes into your ER because of a car wreck, for example, youwill be treating that child," Dr. Levine said.

Dr. Levine's suggestions can be used by outpatient pharmacists,who also need to ensure pediatric drug safety. Technology is animportant component of this goal. Modalities that Dr. Levinediscussed included computerized physician-order entry, barcoding, infusion pumps, automated dispensing capsules, and smartinfusion pumps.

Pediatrics patients are a high-risk population because as theygrow, their body systems mature at different rates, explained Dr.Levine. "It is difficult to create medication dosages for thesepatients, as every dose must be calculated. And manufacturers donot provide many of the dosages [we need]," he said. He added,"There is inconsistency in oral medications in particular." Thisis of concern because the pediatric population is very sensitiveto medication errors.

Ways to reduce errors
Beyond technology, Dr. Levine suggested a number of areas thatall pharmacists can assess to reduce errors. For example, "recordthe age and date of birth," said Dr. Levine. "Often we'll see '3'but without the date of birth, is that 3 months or 3 years ofage?" Pharmacists should also record the child's weight inkilograms. "We would like to see only the metric system used," hesaid. "It is not acceptable to record in pounds and kilograms."Also, when prescriptions are renewed, pharmacists should check onthe child's current weight. The prescription might be a year old,"and we all know how much kids can grow in a year," Dr. Levinesaid. He strongly advised getting a current weight.

Another key element in reducing errors is to get the patient'smedication history. "When doing medication reconciliation, it isimportant to get the dose, volume, and concentration," said Dr.Levine. "Also request information on any commonly used OTC drugsthat the child might be taking. Record all doses in milligrams,not volume. Encourage physicians to write their prescriptions inmilligrams per kilogram." Exceptions to this are medications thatare not weight-based.