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How to Keep Our Children Safe

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Fans of the original version of the television show MacGyver recall a character who is a resourceful problem-solver, using whatever is lying around to fashion a gadget that helps him emerge victoriously from any predicament. Best of all, he does so without causing harm to others.

When it comes to administering medication to pediatric and neonatal patients, many health care providers find themselves in a similar situation to MacGyver as they use their knowledge to modify the medications that have been designed for adults.

While their adaptations are often effective, a recent article explains the challenges of providing safe healthcare for pediatric and neonatal patients. Determining that a patient needs medication is just the beginning. From identifying the right medication, to calculating the dose, to ordering it, to preparing it, to administering it, there are multiple steps and people involved in the process. Combining the complicated process with the wide range in weight of this patient population, the safety risks increase, and errors do occur.

Surprisingly, limited safety resources exist. When it comes to medication use for neonatal and pediatric patients, every step of the process could be improved. “All clinicians” must “play an active role in strengthening medication-use system safety.”

5 Ways to Improve the Pediatric Medication-Use System

  1. Implement a formulary that focuses on pediatrics

A formulary- an official list that includes details about medications and how they can be prescribed- is a must-have for physicians. It includes the most up to date information about the medication and the dosing quantities and routines. Since many medications are “not designed for pediatric use,” doctors end up MacGyvering doses by deducing data from the adult studies that are available. When this happens, the risk of error increases. A pediatric formulary would help standardize the process.

  1. Standardize medication reconciliation

Sometimes, doctors prescribe medications “in terms of milligrams, grams, and other standardized units” while “family members may only know the volume of the medication that they are to administer.” The resulting confusion leads to errors. And when it comes to compounding medicines, “universal adoption of studied formulas has not been embraced widely within the pharmacy community, and individual compounding pharmacies may develop their own formula.” The Standardize 4 Safety initiative has been established in hopes of “regulatingconcentrations of oral and intravenous medications to decrease medication errors.”

  1. Record accurate height and weight information

Medication doses are often based on weight, so accurate information is essential. Not only do clinicians need to record correct weights, but they need to calculate doses correctly. Many errors are the result of substituting kilograms for pounds. In addition to using the wrong unit of measurement, sometimes height and weight get mixed up, and sometimes there are typos in the records. These mistakes underscore the need for a system that “streamlines the transcription process” such as computerized physician order entry (CPOE). These systems come with clinical decision support (CDS) that offers automatic prompts which ask questions and provide additional information. It is important that these systems have interfaces that are designed specifically for neonatal and pediatric patients.

  1. Institute protocols for medication preparation and dispensing

Pediatric and neonatal patients often require their medications to be adjusted. For instance, “tablets or suppositories may need to be cut to deliver a smaller dose, capsules may be opened and mixed with food or beverage prior to administration, or medications manufactured for IV use may be given orally.” These procedures are unvalidated, meaning that no studies have been done to determine their effectiveness. Meanwhile, preparing parenteral (via intravenous) medications for neonatal and pediatric patients “may involve more calculations, dilutions (i.e., aliquots), and manipulation of commercially available products to achieve the desired dose or concentration.” The more complicated the preparation, the more possibility for error. IV workflow management systems, however, have proven to “reduce human error in compounding” by “automating calculations, utilizing barcode scanning for each ingredient prior to mixing, and employing gravimetric analysis to confirm the accuracy of the components included in the solution. Along these lines, when it comes to dispensing medications, color coding has been shown to decrease errors and improve accuracy.

  1. Utilize medication administration technology

Half of all the medication errors in PICU and NICU are caused by medication administration errors. One study found that timing and dosage errors were most prevalent; another identified opiate, antibiotic, and sedative drugs as being the medications most likely associated with administration errors. Technology has helped reduce errors. Barcode scanning enables the correct medicine to get administered to the correct patient at the correct time, and infusion pumps and syringes allow for accurate doses of medications to be administered. Once again, color coding has also proven to reduce errors. Additionally, the FDA has made some recommendations regarding the types of equipment clinicians should use with this patient population.

It is reassuring to see the measures that have been taken to address patient safety when it comes to the complicated process of neonatal and pediatric medication use. In this area, technology has proven to be helpful in reducing errors every step of the process. However, there is still progress to be made in making the youngest, most vulnerable patients safe.

If your child has been a victim of a medical error in any step of the medication process, please contact our experienced Cleveland malpractice lawyers to discuss your options for legal recourse and for obtaining the compensation you deserve. To schedule your free consultation, call 216-687-0900 or contact us online today.