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TABLE 2

Common Medication Risks and Strategies for Improvement

Medication Error RiskStrategies for Improvement
Ordering Phase  
 Not using the appropriate wt and performing medication calculations based on pounds instead of the recognized standard of kilograms.174,175  Pediatric patients are weighed using metric units of measures (in kilograms). 
 Kilogram-only scales are recommended for obtaining weights. 
 Patient wt in kg is entered in the CPOE system before orders are entered. 
 The patient’s wt in kg or g and patient’s age are entered and verified in the pharmacy computer before entering and verifying medication orders. 
 Pharmacist recalculates the dose before preparing and dispensing medications. 
 Making inappropriate calculations including tenfold- dosing errors. Implementation of CPOE and CDS with electronic prescribing.172  
 Dose range checking software is available and enabled in the pharmacy computer. 
 Development of an override algorithm to help reduce overriding of CDS and user variability.176  
 Use of preprinted medication order forms in EDs significantly reduces medication errors and serves as a low-cost substitute for CPOE.177  
 Pharmacists recalculate the dose before preparing and dispensing medications and double-check dosing of medications during resuscitation. Ordering pediatric liquid medications in metric doses. 
 Use of length-based dosing tools when a scale is unavailable or use is not feasible. 
Dispensing and administration  
 Making errors in the medication errors in the 5 rights of medication: the right patient, the right medication, the right dose, the right time, and the right route.178  Standardizing dosage and concentrations available for a given drug, especially for high-risk or frequently used medications (resuscitation medications, vasoactive infusions, narcotics, antibiotics, and look-alike and sound-alike medications. 
 Having readily available and up-to-date medication reference materials. 
 Using premixed intravenous preparations when possible. 
 Having automated dispensing cabinets with appropriate pediatric dosage formulations. 
 Use of a distraction-free medication safety zone to decrease administration errors associated with medication preparation and interruptions.179  
 Implementation of an independent 2-provider check process for high-alert medications. 
 Preparation of intravenous and oral liquid doses includes barcode verification of ingredients. Bedside barcode scanning is used to verify patients and medications and solutions before administration. 
 Use of smart infusion pumps.180  
 Ordering pediatric liquid medications in metric doses.181  
 In code situations, read-back of dose by the medication nurse. 
Medication Error RiskStrategies for Improvement
Ordering Phase  
 Not using the appropriate wt and performing medication calculations based on pounds instead of the recognized standard of kilograms.174,175  Pediatric patients are weighed using metric units of measures (in kilograms). 
 Kilogram-only scales are recommended for obtaining weights. 
 Patient wt in kg is entered in the CPOE system before orders are entered. 
 The patient’s wt in kg or g and patient’s age are entered and verified in the pharmacy computer before entering and verifying medication orders. 
 Pharmacist recalculates the dose before preparing and dispensing medications. 
 Making inappropriate calculations including tenfold- dosing errors. Implementation of CPOE and CDS with electronic prescribing.172  
 Dose range checking software is available and enabled in the pharmacy computer. 
 Development of an override algorithm to help reduce overriding of CDS and user variability.176  
 Use of preprinted medication order forms in EDs significantly reduces medication errors and serves as a low-cost substitute for CPOE.177  
 Pharmacists recalculate the dose before preparing and dispensing medications and double-check dosing of medications during resuscitation. Ordering pediatric liquid medications in metric doses. 
 Use of length-based dosing tools when a scale is unavailable or use is not feasible. 
Dispensing and administration  
 Making errors in the medication errors in the 5 rights of medication: the right patient, the right medication, the right dose, the right time, and the right route.178  Standardizing dosage and concentrations available for a given drug, especially for high-risk or frequently used medications (resuscitation medications, vasoactive infusions, narcotics, antibiotics, and look-alike and sound-alike medications. 
 Having readily available and up-to-date medication reference materials. 
 Using premixed intravenous preparations when possible. 
 Having automated dispensing cabinets with appropriate pediatric dosage formulations. 
 Use of a distraction-free medication safety zone to decrease administration errors associated with medication preparation and interruptions.179  
 Implementation of an independent 2-provider check process for high-alert medications. 
 Preparation of intravenous and oral liquid doses includes barcode verification of ingredients. Bedside barcode scanning is used to verify patients and medications and solutions before administration. 
 Use of smart infusion pumps.180  
 Ordering pediatric liquid medications in metric doses.181  
 In code situations, read-back of dose by the medication nurse. 

CDS indicates clinical decision support; CPOE, computerized physician order entry.

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