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Guidelines Seek to Reduce Medication Errors Involving Kids

A key recommendation is measuring a child's weight in kilograms

FRIDAY, April 11 (HealthDay News) -- The group that accredits most U.S. hospitals issued guidelines Friday to help prevent medication errors in hospitalized children.

Among the recommendations: Children should be weighed in kilograms -- the global standard and the standard for medication dosing -- when they are admitted to a hospital.

"The vast majority of countries utilize the metric system, and the recommendations for pediatric medication use are based on the metric system," said Dr. Peter Angood, vice president and chief patient safety officer for The Joint Commission, which announced the "Sentinel Event Alert" at a teleconference.

"Sadly, there seems to be a lack of widespread appreciation even among health-care providers that children have unique safety and medication needs," said Dr. Matthew Scanlon, assistant professor of pediatrics-critical care at the Medical College of Wisconsin and a member of the Joint Commission's Sentinel Event Advisory Group. "The issues of having to adapt products -- be it technology or medications -- that were created for adults and apply those to pediatric patients is terribly problematic and really is the source of a great deal of work that has to be performed on a daily basis among pediatric health-care providers."

Added Catherine Tom-Revzon, clinical pharmacy manager at Children's Hospital at Montefiore in New York City: "This is definitely increasing the public awareness that at least something's being done to address the medication errors that occur in children."

The alert follows publication this week of a study that found that medication errors, including accidental overdoses and adverse reactions, affect about one of 15 -- or 7 percent -- of hospitalized children. The study was published in the April issue of the journal Pediatrics.

That 7 percent figure is much higher than previous estimates. And it underscores growing concerns about medical errors involving hospitalized children -- an issue that generated headlines in November when actor Dennis Quaid's newborn twins were accidentally given life-threatening overdoses of a blood thinner.

What's to blame for the problem? According to Angood, most medications are made and packaged for adults, and most health-care facilities are built and organized around the needs of adults, not children. Also, process issues -- including miscommunication, lack of standards for labeling and packaging, and the misidentification of medications -- are at fault, he said.

Even recent innovations in technology often don't help the pediatric population. A system for computer order entry of medications implemented by Scanlon's hospital did not have weight-based dosing. "Pediatric providers were left to cobble together weight-based dosing," he said.

Similarly, bar coding of medications is sometimes not readable for children because of the range of size.

"Technology holds great promise," Scanlon said. "Unfortunately, today, that hasn't been realized and lack of explicit attention to the needs of children certainly has not helped that matter."

Perhaps the simplest solution proposed by the commission is for hospitals and health-care providers to weigh children in kilograms to arrive at the proper dosing.

"This should become the standard of recording pediatric patient weights," Angood said.

The commission is also suggesting that caregivers who prescribe medications to children be required to write out and document how they arrived at particular doses. "In other words, show the math," Angood said. "This means nurses or doctors can easily double-check the calculations of any medications administered."

The family and, if possible, the child should also be involved in the medication management process, and should be asked to repeat back any medication-related instructions, according to the guidelines.

"What's really important from the patient's or parents' perspective is not only know the child's weight [in kilograms] but also maintain a current list of a child's medications -- whether they be prescription, over-the-counter or both," Tom-Revzon said. "Also, as part of that list, it should include any allergies to medication or foods, so that even if the child doesn't end up going to the hospital, even if they go to the emergency [room] or to a different doctor, that list will help prevent potential drug interactions and duplications."

Angood added: "We can and we're obligated to do better. We really do owe it to those patients who depend on us."

More information

To learn more about the new recommendations, visit The Joint Commission.

SOURCES: Catherine Tom-Revzon, PharmD., clinical pharmacy manager, pediatrics, Children's Hospital at Montefiore, New York City; April 11, 2008, teleconference with Peter Angood, M.D., vice president and chief patient safety officer, The Joint Commission, Oakbrook Terrace, Ill., Matthew Scanlon, M.D., assistant professor of pediatrics-critical care, Medical College of Wisconsin and member, Joint Commission's Sentinel Event Advisory Group

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