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Medication Administration

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Rachelle Kwong

on 16 September 2013

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Transcript of Medication Administration

PEDIATRIC MEDICATION ADMINISTRATION

Dosage Considerations
Physiological Considerations
(Hsu, 2013; Luisito, n.d.)
Medication Administration Errors
Sears et al., 2013
Studied the nursing work environment & occurrence of reported medication errors.
In a 3 month study period, 127 potential and 245 actual errors were reported
Most frequent errors were wrong time & wrong dose
Workload, distraction, & ineffective communication were significant contributing factors to errors
Rachelle Kwong
NURS 3000
September 16, 2013

Maintenance Fluid Requirements
Holliday & Segar Method (1957)
Body Weight Based Dosing
Always in kilograms (remember 1 kg = 2.2 lbs)
Often expressed as mg/kg/day or mg/kg/dose
mg/kg/d = needs clarification!


Most accurate
Expressed as mg/m2
Takes into consideration both height & weight of the patient
Calculated using the West Nomogram
BSA is used to calculate pediatric dose from an adult dose
IV Insertion Tips
Medication Adminstration Tips
Learning Objectives
Body Surface Area Dosing
Ordered: Ampicillin 125mg IV q6h
What is the mg/kg/dose?
Doses are calculated by weight or body surface area (BSA)
Few standardized pediatric dosage ranges
Drugs prescribed for infants and children are not available in the appropriate dosage & preparation

Sources of Medication Errors
Common use of both milligrams & micrograms
10 fold medication errors
Customization of individual dose
Off-label uses of drugs
Various preparations of medications - elixirs, chewable tablets, drops, capsules

(Perry et al., 2013)
(Unbound Medicine, 2013)
Perform IV insertion outside the child's hospital room
Use various distraction techniques:
Allow parents to stay with their child
Be honest
Use a topical anesthetic (ex. EMLA)
Lidocaine & prilocaine in a cream
Results in numbness
Requires ~1 hr to achieve peak effect
Summary
Give children choices whenever possible
Do not give a choice when there isn't one
Give the child a small popsicle or ice cube to numb the tongue before giving medication
Prevent the experience of unpleasant tastes by pinching the child's nose
Mix medication with some apple sauce or ice cream (after checking w/ pharmacy)
After this presenation, you will be able to:
Describe dosage differences in pediatrics and why they contribute to medication errors
Calculate pediatric medication dosages and determine safe & therapeutic drug ranges
Name 3 tips for medication administration and IV insertion in children
Recommendations:
Improve environment for medication administration
Increase level of professional education
Increase interdisciplinary communication
Standardize medication delivery
PO: (Children 1–12 yr):
10–15 mg/kg/dose
q 4–6 hr as needed (not to exceed 5 doses/24 hr)
Acetaminophen Example
(Unbound Medicine, 2013)
(160 mg/dose) / 10.5kg =
15 mg/kg/dose
Ordered for Mandeep:
160 mg
PO qid prn
Mandeep =
10.5 kg
Is Mandeep's dose within the recommended range?
Mandeep's dosage
Ordered dose
Child's weight in kilograms
Divide the ordered dose by child's weight
125 mg/dose
10.5 kg
(125 mg/dose) / 10.5kg =
12 mg/kg/dose
What is the mg/kg/day?
125 mg x 4 doses = 500 mg/day
(500mg/day) / 10.5kg =
48 mg/kg/day
Ampicillin 125mg IV q6h
Answer
First 10 kg (0-10 kg) = 100mL/kg/day
Additional kg (from 11-20kg) = 50mL/kg/day
Additional kg (21+kg) = 20mL/kg/day
Mandeep's Maintenance Fluid Requirement
10 kg x 100 mL/kg/day = 1000 mL/day
0.5 kg x 50 mL/kg/day = 25 mL/day

Total = 1025 mL/day
What is Mandeep's maintenance fluid requirement?
(Perry et al., 2010)
(Sears et al., 2013)
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Dosage differences in pediatrics that contribute to medication errors
Calculate pediatric medication dosages and determine whether a dose is safe
Tips for medication administration and IV insertion in children
What is the mg/kg/day?
Is Mandeep's dose within the recommended range?
YES!
Full transcript