A modified Delphi to define drug dosing errors in pediatric critical care
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RESEARCH ARTICLE
Open Access
A modified Delphi to define drug dosing errors in pediatric critical care Nadia Roumeliotis1,2,3* , Eleanor Pullenayegum2,3, Paula Rochon4,5,6, Anna Taddio2,7 and Chris Parshuram1,2,3,8
Abstract Background: There is no globally accepted definition for dosing error in adult or pediatric practice. The definition of pediatric dosing error varies greatly in the literature. The objective of this study was to develop a framework, informed by a set of principles, for a clinician-based definition of drug dosing errors in critically ill children, and to identify the range that practitioners agree is a dosing error for different drug classes and clinical scenarios. Methods: We conducted a nationwide three staged modified Delphi from May to December 2019. Expert clinicians included Canadian pediatric intensive care unit (PICU) physicians, pharmacists and nurses, with a least 5 years’ experience. Outcomes were underlying principles of drug dosing, and error thresholds, as defined by proportion above and below reference range, for common PICU medications and clinical scenarios. Results: Forty-four participants met eligibility, and response rates were 95, 86 and 84% for all three rounds respectively. Consensus was achieved for 13 of 15 principles, and 23 of 30 error thresholds. An over-dosed drug that is intercepted, an under-dose of a possibly life-saving medication, dosing 50% above or below target range and not adjusting for a drug interaction were agreed principles of dosing error. Altough there remained much uncertainty in defining dosing error, expert clinicians agreed that, for most medication categories and clinical scenarios, dosing over or below 10% of reference range was considered an error threshold. Conclusion: Dosing principles and threshold are complex in pediatric critical care, and expert clinicians were uncertain about whether many scenarios were considered in error. For most intermittent medications, dosing over 10% below or above reference range was considered a dosing error, although this was largely influenced by clinical context and drug properties. This consensus driven error threshold will help guide routine clinical dosing practice, standardized reporting and drug quality improvement in pediatric critical care. Keywords: Dosing, Error, Pediatrics, Critical care
Background Dosing errors are the amongst the most common types of medication error in pediatric practice, along with incomplete and incorrect prescription preparation [1–6]. .Pediatric drug dosing is particularly challenging due to a child’s growth, development and change in organ * Correspondence: [email protected] 1 Department of Critical Care Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada 2 Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Canada Full list of author information is available at the end of the article
function over time. Dosing in children is therefore weight-based, involves the dilution of concentrated stock solutions, and th
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