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      Dosage Error in Pediatrics

      Focus: Underdosing - Unerestimated ans Underappreciated

      Avoiding medication errors is, of course, important in the entire field of medicine. In neonates, infants, and children, however, it is absolutely crucial as their physiological reserve is so much smaller than in adults: An improper dose that might pass unnoticed or results in more side effects in an adult can quickly become life-threatening in our youngest patients – and that includes underdosing, the oft neglected stepchild of dosage errors.

      pediatric nurse regulated drip chamber

      One of the most frequent causes of underdosing is the incomplete delivery of the container content:

      In 50 mL infusions, up to 32.2% of the active compound remains in the IV line.8, 9

      50 mL IV antibiotics may be underdosed by up to 50%.10

      Note: therapeutic index = gap between minimum dose (minimally effective amount of active substance) and maximum dose (maximum amount of active substance applicable without causing a health risk).

      Dos & Don´ts

      Risk Prevention in Pediatrics & Neonatology

      Do you want to know more about the risk of medication errors? Read more about the general risk. 

      Get in contact

      Pediatrics & Neonatology

      B. Braun Melsungen AG

      Carl-Braun-Str. 1

      34212 Melsungen,

      Germany

      [1]  Miller RM et al, Qual Saf Health Care 2007;16:116-126.

      [2]  Cowley E et al, Curr Ther Res Clin Ex 2001, doi: 10.1016/W0011-393(01)80069-2.

      [3]  James JT, J Patient Saf 2013;9:122-128.

      [4]  Valentin A et al, Intensive Care Med 2006;32:1591-1598.

      [5]  Conroy S et al, Drug Saf 2007;30:1111-1125.

      [6]  Neuspiel DR et al, Health Serv Insights 2013;6:47-59.

      [7]  Zakharov S et al, Ups J Med Sci 2012;117:309-317.

      [8]  Plagge H et al, Pharma Publishing and Media Europe 2010;16:31-37.

      [9]  Federal Institute of Drugs and Medicinal Devices 2015; The Forgotten Residue: Dead Volumes of Short-term Infusions, Pub. No. 2.

      [10]  https://www.england.nhs.uk/signuptosafety/wp-content/uploads/sites/16/2015/11/su2s-infusing-iv-antibiotics-webinar.pdf.

      [11] Gregerson BG et al, Proc Bayl Univ Med Cent 2018;31(2):168-170.

      [12] Lilienthal N, The Forgotten Residue, Federal Institute of Drugs and Medicinal Devices (BfArM).

      [13] Lala AC et al, Journal of Paediatrics and Child Health 2015;51:478-481.

      [14] Mitteilung Deutsches Ärzteblatt 2017;114:40,1835-1836.

      [15] Conn R et al, the Pharmaceutical Journal 2018, https://pharmaceutical-journal.com/article/ld/prescribing-errors-in-children-why-they-happen-and-how-to-prevent-them.

      [16] Physician Insurers Association of America. Medication Errors Symposium White Papers. Washington, DC: Physician Insurers Association of America; 2000.

      [17] Kohn L et al, (2000) To Err Is Human: Building a Safer Health System. Washington, DC: Committee on Quality of Health Care in America, Institute of Medicine. National Academies Press, ISBN: 9780309068376.

      [18] Walsh EK et al, Pharmacoepidemiol Drug Saf 2017;26(5):481-497.

      [19] Pinilla J et al, The European Journal of Health Economics 7(1):66-71.

      [20] WHO (2013): Hospital Care for Children. Guidelines for the Management of Common Childhood Illnesses. 2nd edition, Geneva.