One of the most important ways to prevent a catastrophic drug-dosing error in the emergency department (ED) comes down to a simple safety precaution: Weigh all patients in kilograms only.
That’s the recommendation in an updated AAP-endorsed statement from the Emergency Nurses Association (ENA). The Academy also endorsed the ENA’s 2012 statement calling for use of kilograms in the ED.
Weighing All Patients in Kilograms is available at http://bit.ly/2uqdBc8 and will be announced in the October issue of Pediatrics. The endorsement aligns with guidance from the Academy and other organizations (see resources).
More than 40% of fatal medication errors can be traced to dosing errors, according to the position statement. Children are especially vulnerable. When weight is recorded incorrectly in any pediatric setting, it can trigger a host of medical errors. Errors that originate in the ED, for example, can follow the patient throughout a hospital visit.
The position statement includes the following recommendations aimed at EDs:
- Patient weights should be measured, recorded and displayed in a prominent place in the medical record in kilograms only.
- Multiple types of scales should be available in the emergency setting, all configured to record weights in kilograms only.
- For patients under age 18 years, clinical decision support features should be used to compare weight with expected weight (such as based on growth charts) and provide real-time alerts whether under-dose or over-dose is suspected.
- Electronic medical records (EMRs) should allow for weight entries only in kilograms. Institutions should consider integrating digital scales with the EMR to eliminate or reduce the need for data entry.
- The patient’s weight in kilograms should be included on all prescriptions and in all inter- and intra-disciplinary patient hand-offs.