The Impact of Calculation Errors on Pediatric Drug Administration

This report investigates the critical issue of pediatric drug calculation errors in healthcare settings, drawing on observations from a pediatric facility. It highlights the increased vulnerability of pediatric patients to medication errors, emphasizing that children are at a higher risk of adverse drug events compared to adults, especially due to immature physiology, developmental limitations, and the need for weight-based dosage calculations. The report examines the various stages where errors occur, with a focus on the prescribing and administration phases, and underscores the nurses' crucial role as a barrier against medication errors. It discusses the methods used in pediatric dose calculations, including weight-based methods, body surface area, and considerations for premature infants. The report concludes by emphasizing the complexity of administering pediatric medications, the importance of accurate calculations involving percentages, fractions, and decimals, and the need for improved mathematical skills among nurses to prevent pediatric medication errors, supported by a comprehensive review of relevant literature.

PEDIATRIC DRUGS AND CALCULATIONS 1
PEDIATRIC DRUGS AND CALCULATIONS
Student’s Name
Institutional Affiliation

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Pediatric Drugs and Calculations
A medication error is termed as the preventable and improper utilization of medication,
which may happen at any phase of the medication process and constitutes transcribing orders,
ordering, administering, dispensing, and monitoring. The medication errors can be in
different forms and do not emerge as a result of death or injury. I visited a pediatric facility
and noted that the pediatric patients were highly exposed to harm during treatment, and
medication errors were majorly preventable and common. When there was an occurrence of
a medication error, pediatric patients were extremely at risk of death in comparison to the
adults. They were100 errors that were undetected in the situation that there was an occurrence
of a medication error that could cause harm to an adult patient. Furthermore, an adverse drug
event is an estimate of a single error in every composition of 100 medication errors, and the
patient may end up dying or harmed. I was surprised to realize that there is a likelihood of
pediatric medication error to wobble being considerate of the amount of outpatient and
inpatient medical prescriptions that were being written every single day (Lai & Chan, 2015).
On the other hand, while doing my research, I noted numerous studies that were conducted
evaluated that there was a range of 4.5-5.7 of medication errors in children in every 100
medication orders (Hoyle et al., 2016). These results were similar to inpatients adults.
Therefore, the Pediatric outpatients were three times highly exposed to the danger of adverse
drug reaction in comparison to the outpatient's adults (Ewig, Cheung, Kam, Wong &
Knoderer, 2017). As a result of fewer balances and checks, the rate of prevention of Pediatric
medication error was great in the ambulatory setting.
Ordering or prescribing phase was the stage that the majority of the medication errors
occurred then closely followed by the administration phase (Hagberg et al., 2016). The nurses
played a major role in Pediatric medication errors, and the majority of the errors were
conducted before drug administration. When the nurse failed to intercept or spot a medication

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error, it led to an adverse event. This is because the nurses were the latent barriers amid
critical harm and medication error, such as a wrong medication being administered at the
wrong time. It was the duty of the nurses to ensure that the patients received the right
medication at the appropriate time and also to monitor the patient’s reactions or behavior
after the administration to observe any possibility of an adverse event.
As a result of immature physiology, the adolescent and children were at high risk of
medication errors in comparison to the adults. In addition, they had a developmental
limitation that had an impact on their capability to self -administer medication and
communicate. Dosage guidelines and pediatric indications were often not included in the
medications and were based on dilution and weight. Therefore, a larger proportion of
medications were generated for the adults in comparison to the children. In order for drugs to
be administered in large proportion to the children, drug calculation had to be conducted to
administer safe dosages. The nurses often faced complications in administering pediatric
dosages because they had to be calculated in accordance with the child's weight (Avidan,
Levin, Weissman & Gozal, 2014). Thus the children who took this type of medication were at
high risk of medication errors due to the dosage calculations that were required. There was a
minimal risk when there was no calculation needed. The group of children that were highly
vulnerable to medication error consisted of; the children who were placed in ICUs,
particularly the neonatal ICUs, those who were less than two years of age, and those that
were obtaining chemotherapy (Hirani & Farlane, 2016). Additionally, the children whose
weight had not been noted, those who were obtaining IV medication, and those who were in
EDs and in critical condition.
Off- label medication was safe for children's usage when it was properly understood by the
clinicians who were in charge of the patient's treatment (Gomes, da Silva, Chagas & dos
Santos Magalhães, 2015). The majority of the medication that was child affiliated did not

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contain information and guidelines, efficacy or safety information, and adverse effects.
Children were placed into a high risk of a medication error when they used off- label
application that the Food and Drug Administration (FDA) had not approved.
When an adult dosage was given to a child without putting into consideration the child's
age, weight, and clinical conditions, this led to an overdose, which resulted in death or
toxicity. Determination of the fraction of an adult dosage was a commonly utilized method
when calculating pediatric doses. This type of calculation was used on children who weighed
less than 40kg and 12 years of age and below. These calculations were valid and had been
utilized for more than 50 years globally for the treatment of pediatric patients (Saraghi,
Moore & Hersh, 2015). However, it was essential to note that the calculated fraction of the
adult dosage was toxic on particular occasions, depending on the child's physiology, health
condition, and status.
Weight Based Method
This equation was utilized in the calculation of the pediatric dose on the basis of the
weight of the child in kilograms.
Body Surface Area (BSA)
This type of dosage calculation was conducted on the medications that had a minimal
therapeutic -toxic ratio. A nomogram was utilized in dose determination on the basis of the
genuine size of the child through the use of a child's weight in kilograms and height in
centimeters.

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Prematurity Status
Special consideration was offered to premature newborns of less than 30 weeks gestation
during dosage calculation. Therefore the premature infants were given minimal dosage in
comparison to the other infants. The premature infants often had unique physiological
features such as great levels of extracellular body water, little gastrointestinal motility,
reduced plasma protein binding, and little total body fat composition.
Dilution
This method was utilized when the adult dosage was in liquid form, and the pediatric dose
had to be prepared from it.
In conclusion, I observed that administering pediatric medication could be complex due to
the mathematical calculation that a clinician had to perform. Percentages, fractions, ratios,
and decimals were the most common calculations. Incompetence to calculate the therapeutic
dosage volume of drugs led to a high rate of pediatric medication error. I noted that the nurses

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had poor mathematical skills in comparison to pharmacists and physicians on the basis of a
mathematical test that the new interns were often given.

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References
Avidan, A., Levin, P. D., Weissman, C., & Gozal, Y. (2014). Anesthesiologists' ability in
calculating weight-based concentrations for pediatric drug infusions: an observational
study. Journal of clinical anesthesia, 26(4), 276-280.
Ewig, C. L., Cheung, H. M., Kam, K. H., Wong, H. L., & Knoderer, C. A. (2017).
Occurrence of potential adverse drug events from prescribing errors in a pediatric
intensive and high dependency unit in Hong Kong: An observational study. Pediatric
Drugs, 19(4), 347-355.
Gomes, V. P., da Silva, K. M., Chagas, S. O., & dos Santos Magalhães, I. R. (2015). Off-
label and unlicensed utilization of drugs in a Brazilian pediatric hospital. Farm
Hosp, 39(3), 176-180.
Hagberg, H., Siebert, J., Gervaix, A., Daehne, P., Lovis, C., Manzano, S., & Ehrler, F.
(2016). Improving Drugs Administration Safety in Pediatric Resuscitation Using Mobile
Technology. In Nursing Informatics (pp. 656-657).
Hirani, S. A. A., & Farlane, J. M. (2016). Medication errors by novice nurses in a pediatric
and neonatal care setting of Pakistan: Analysis of problems and proposed
solutions. Pediatr Neonatal Nurs, 2(1).
Hoyle Jr, J. D., Sleight, D., Henry, R., Chassee, T., Fales, B., & Mavis, B. (2016). Pediatric
prehospital medication dosing errors: a mixed-methods study. Prehospital Emergency
Care, 20(1), 117-124.
Lai, P. S. M., & Chan, Y. K. (2015). Dosage Forms, Drug Calculations and Prescription.
In Pharmacological Basis of Acute Care (pp. 73-79). Springer, Cham.
Saraghi, M., Moore, P. A., & Hersh, E. V. (2015). Local anesthetic calculations: avoiding
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