Automated Dose-Rounding Recommendations for Pediatric Medications

Johnson, Kevin B.; Lee, Carlton K. K.; Spooner, S. Andrew; Davison, C.; Helmke, Jill S.; Weinberg, Stuart T.

doi:10.1542/peds.2011-0760

Cited by 38 publications

(39 citation statements)

References 14 publications

(14 reference statements)

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“…In an effort to establish a more consistent definition of appropriateness of dose-rounding, Johnson and colleagues 8 conducted an interview of 19 pediatric health care professional experts. The investigators also conducted a literature review and used a Delphi model to establish consensus recommendations for appropriateness of dose rounding in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

“…Last, there is a lack of consistent definition of what an unmeasurable or unrounded dose is, as well as which specific agents are appropriate to round. The previous study by Johnson and colleagues 8 provides some guidance, but their consensus recommendations have limited utility to many medications used in the inpatient setting. Without an appropriate understanding of the number of significant digits that account for an unmeasurable dose as well as what constitutes an appropriate rounding percentage per agent, it is difficult to provide dosage recommendations for all agents, specifically for medications with a narrow window of therapeutics.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of Unrounded Medication Doses and Associated Factors Among Hospitalized Pediatric Patients

Jones

Miller

Neely

et al. 2017

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVESThis study aims to determine the prevalence and factors associated with unrounded doses ordered via a computerized prescriber order entry (CPOE) system among children during a 1-week reference period.METHODS This retrospective, cross-sectional study included children younger than 18 years admitted during a 7-day period. An unrounded dose was defined as an unrounded actual dose (eg, dose calculated to the tenths place for non-neonatal intensive care (non-NICU) patients and dose calculated to the hundredth place for NICU patients) or unrounded volume per dose [eg, <0.1 mL for non-NICU patients and <0.01 mL for NICU patients]. A multilevel logistic regression model was used to determine the prevalence and factors associated with unrounded doses via a CPOE system with adjustment for clustering effects. RESULTSA total of 395 patients were admitted with 391 receiving medications. The overall prevalence of unrounded doses was 30% among the 2426 doses administered. Patients on the NICU team had the highest prevalence of unrounded doses. The odds of an unrounded dose were 4% (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) lower with each additional kilogram increase in weight after controlling for age, route, scheduled versus as-needed administration, and cluster effects.CONCLUSIONS The prevalence of unrounded doses was higher than in previous studies. It was higher in smaller children after controlling for age, medication-related variables, and clustering. Future studies should focus on the role of CPOE in preventing unrounded and unmeasurable doses and if these strategies affect clinical outcomes (eg, adverse drug events).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of Unrounded Medication Doses and Associated Factors Among Hospitalized Pediatric Patients

Jones

Miller

Neely

et al. 2017

The Journal of Pediatric Pharmacology and Therapeutics

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“…MacKay et al 13 describe the development of pediatric standard doses for 11 oral medications; however, neonatal patients, especially low birthweight ones, are not specifically addressed. Johnson et al 14 created a list of commonly prescribed medications with dose-rounding information for the pediatric population. Johnson and colleagues 14 adapted the Delphi model and recruited a group of national experts to complete the consensus of dose-rounding recommendations.…”

Section: -4500mentioning

confidence: 99%

“…Johnson et al 14 created a list of commonly prescribed medications with dose-rounding information for the pediatric population. Johnson and colleagues 14 adapted the Delphi model and recruited a group of national experts to complete the consensus of dose-rounding recommendations. In contrast, this project used the nominal group technique and listed individual standard drug doses with the neonate's respective weight.…”

Section: -4500mentioning

confidence: 99%

Standard Dose Development for Medications Commonly Used in the Neonatal Intensive Care Unit

Robinson

Siu

Meyers

et al. 2014

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES:To establish standardized, rounded doses of medications for neonates in the neonatal intensive care unit (NICU) through a multi-institutional peer-reviewed process. METHODS: Pediatric faculty and pediatric pharmacy residents from the Ernest Mario School of Pharmacy (Piscataway, NJ) conducted a systematic review of rounded, weight-based medication information for neonatal patients from September 2010 to April 2011. After initial review, an expanded workgroup of expert neonatal pharmacy clinicians from academic institutions throughout the United States were invited to conduct a final review. The workgroup identified 74 medications or indications in the NICU. Recommended standardized doses were established for discrete weight categories at workgroup consensus web meetings conducted from June to December 2011. Workgroup recommendations were cross-referenced with published neonatal pharmacology resources. Consensus was obtained when references provided insufficient information on medication information. RESULTS: Seventeen weight categories of increasing ranges were used, from 40 g for the lowest weights (e.g., 410-450 g) to 840 g for the highest weights (e.g., 3660-4500 g). Medications were divided into 3 categories of administration routes: oral (n = 4), intermittent intravenous (n = 64), and other (e.g., intramuscular; n=6). A significant majority of standardized doses (84%) were within 15% of their corresponding weight-calculated dose. CONCLUSIONS: Establishment of a portfolio of standardized, rounded doses of medications commonly used in the NICU was feasibly established by a multi-institutional peer review process, with the great majority of standardized doses being within clinically acceptable ranges of administration. Use of standardized, rounded doses for reduction in dosing errors may be feasible on a systematic level.

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“…5 While no federal regulatory r equirements currently exist in the United States to dictate which devices healthcare systems must use, position statements supporting the use of ENFit ® as an option for preventing tubing misconnections have been released. 11 The standard female syringe allows for significant dead space in the syringe tip (up to 0.2 mL), yielding unacceptable dosing variance and excessive drug delivery with low volume doses. 8,9 In addition to operational chall enges in the implementation process, potential significant safety risks have been noted.…”

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confidence: 99%

Female low dose tip syringes‐increased complexity of use may compromise dosing accuracy in paediatric patients

2019

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Summary What is known and objective The International Organization for Standardization (ISO) created enteral device specifications to reduce tubing misconnections. The Global Enteral Device Supplier Association (GEDSA) supports a female design: standard and low dose tip (LDT). Concerns include increased complexity of use with adapters, dosing accuracy and workflow. No peer‐reviewed studies have evaluated dosing accuracy of the complete female system with adapters. The objective of this study was to compare dosing accuracy of the female design to legacy syringes. Methods An in vitro study was conducted at the University of Florida College of Pharmacy pharmaceutics laboratory. Assessments were completed for syringe size, dispense methods and volumes, and adapters when applicable. A gravimetric scale and specific gravity were used to calculate administration volumes. The primary outcome was frequency administration volume exceeded 10% expected amount. Results and discussion A total of 576 tests were performed. The LDT resulted in significantly higher rates of unacceptable dosing variance compared to legacy (21.2% vs 7.4%, P = 0.003). Variance exceeding 10% occurred more frequently with LDT 0.5 and 1 mL syringes, medication cup dispensing (liquid or tablet) and inappropriate LDT adapter use. Unapproved adapter processes compared to FDA‐approved processes held a higher likelihood of unacceptable dosing variance (28% vs 7.4%, P < 0.001). FDA‐approved use of adapters with prefilled syringes compared to bedside administration may result in higher rates of dosing inaccuracy (18.8% vs 5.6%, P = 0.06). What is new and conclusions This study raises clinical concerns of dosing inaccuracies with the LDT syringes, particularly with 0.5 and 1 mL sizes. The use of adapters significantly increases the opportunity for inaccurate dosing.

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Automated Dose-Rounding Recommendations for Pediatric Medications

Cited by 38 publications

References 14 publications

Prevalence of Unrounded Medication Doses and Associated Factors Among Hospitalized Pediatric Patients

Prevalence of Unrounded Medication Doses and Associated Factors Among Hospitalized Pediatric Patients

Standard Dose Development for Medications Commonly Used in the Neonatal Intensive Care Unit

Female low dose tip syringes‐increased complexity of use may compromise dosing accuracy in paediatric patients

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