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Discussion

Pre-calculation of emergency meds?

Working on a process improvement project. We are a trauma center and do accept fairly stable children. The kids all come to the unit I work on which is adult surgical (not ortho) and all pediatrics. We are using the Broselow cart and Kangaband system.

I am wondering if there are hospitals out there that precalculate PALS medications and post at the head of bed of children? This would eliminate drug calculations at the point of care in emergency situations.

If your hospital does, is there a program you use or who does the calculations? Do you recalculate with new daily weights?

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    We have emergency drug sheets printed for every patient. Our clinical pharmacist created an Excel spreadsheet with the doses and equations embedded so all we're required to do is enter the child's weight and age into the software. The only time we update them is when they've been with us for several weeks and there has been an appreciable change in weight; much of the weight changes we see are fluid volume related and not thought to make a difference in drug doses or efficacy.

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    Every baby in the NICU has a code sheet that is attached to the crib/warmer/isolette and a second copy in the patient's chart. New code sheets are printed every week. The weights are entered into EPIC and printed. We do not do the calculations by hand, the software does it for us.

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    We had drug cards when I worked in the hospital. There was a binder with all of them on our code cart. It had all of the doses for code medications for a child who weighed 20 kg, for example.

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    We have a computer program that we enter the patient's weight into and a list of pre-calculated emergency medication doses and volumes (for standard concentrations).

    2 copies of our emergency med list stay at the bedside- one for the code team leader and one for the medication nurses and an additional copy goes in the patient chart. We re-print new lists every week (even if the weight hasn't changed) or anytime a patient has an updated "weight for ordering" in the computer.

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    This stuff is on my mind lately, as I am studying for CPEN.

    I am in a general, not pedi ER, and work for an organization that doesn't really push for best practices, so all I learn and do is for my own learning and skill development.

    I personally use Blue Card.

    I did find an electronic Braselow, that appears to do exactly what you want. Have you looked at that?

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    We have a code sheet at bedside for each patient based on their weight.

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    Every place I've worked with has a calculated medication code book at the code cart, so you open the book to the patient's weight and the emergency meds are calculated by dose and by the ml you draw up based on the concentration we stock in the cart.

    I've seen it be pretty standard to post code meds above the patient's bed- this is usually calculated with every patient weight by the RN taking care of the patient and double checked by a second RN. I'm pretty sure code books are delegated tasks but then checked by pharmacy (I think at one place the unit educator compiled the book with pharmacy, at my current place I believe it was the hospital's medication safety committee and then checked by pharmacy.

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