Pediatric/Neonatal medication administration

[tinypepsnrs2018]

I am a nursing student precepting in a NICU at a hospital where they do not have the nurses draw-up or check medication dosages via weight-based calculations prior to administration. Basically the provider writes the order as mg/dose, pharmacy fills it, and then I am supposed to trust that the medication is what pharmacy says it is and appropriate for the baby's size. When I worked at a different hospital, prior to nursing school, all pediatric medications the provider ordered were ordered as mg/kg, the dose would be checked by pharmacy and then two nurses on the unit would calculate the dose prior to the nurse drawing up and administering the medication. I feel like having the extra checks would prevent mistakes, and I am constantly worried about medication errors at the hospital I am precepting at. I was wondering how other facilities handle medication administration for pediatric patients.

[NICU Guy, BSN, RN]

Most of our scheduled medications are already pre-filled by pharmacy and checked by the pharmacist. Once we scan the medication on the EMAR, it will display all of the information: dose (mg/kg for oral and mg/kg/hr for IV), concentration (mg/mL), dose in mL (how much is in syringe), and length of administration for IV meds. We verify the math and the correct mL in the syringe. We theoretically double checking the pre-filled medications: pharmacist/nurse. Anything we draw up personally is double checked nurse/nurse.

[NotReady4PrimeTime, RN]

There are at least as many checks performed in the pharmacy when they prepare medications as there are on the floor. I was a pharmacy technician in another life, and ALL of my work was double-checked by a pharmacist, from the original order and dosage calculation to my transcription into the computer to the actual preparation. While it is possible that mistakes are made in the pharmacy, it's MORE likely that they happen on the floor. Just as an aside, it's far more cost-effective to have pharmacy prepare unit doses of most drugs. There's significantly less waste of drugs there compared with the various inpatient units; the risk of infection is also lower since IV meds are mixed and drawn up under a hood. But as the above poster has said, you still are required to ensure the dose is safe for the patient and that the syringe/blister pack contains the amount of drug stated on the label.

[NICUmiiki, DNP, NP]

You can still check the dosage based on weight and the math... but yes, you have to trust that the med in the syringe is what they say it is.

[Wuzzie]

Ummmm, why wouldn't you trust a pharmacist to accurately draw up a medication dose? That IS what they went to school for (among many other things). In fact it's probably safe to say they know more about the medications than we nurses do. They have doctorates in it after all. That being said a smart nurse will always check the dose and the syringe prior to administration. I think some time shadowing the pharmacists might be a real eye-opener for you.

[Leader25, ASN, BSN, RN]

Even if prepared by Pharmacy,we check calculation mg/kg ask co worker to double check narcotic med.,have Neofax book to carefully check meds.

[KelRN215, BSN, RN]

When I worked in the hospital, the MD or NP entered the dose order in mg but both the nurse and the Pharmacist had to verify the order. By doing so, you were signing off that you had verified that the dose was safe which meant checking the mg/kg calculation. I don't really see why it makes a difference if the provider enters Keppra 200 mg BID for a 20 kg child or Keppra 10 mg/kg BID and the eMAR calculates the dose to 200 mg BID because the weight is 20 kg. Either way it's 200 mg BID and everyone is responsible for ensuring that this is a safe dose for this child. And yes, the pharmacy would have dispensed this in unit dosed syringes of 200 mg/2mL labeled with the patient's name, DOB, MRN and Keppra 200 mg.