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An Innovative Approach to Pediatric Dose Standardization
An innovative approach to pediatric dosing was presented at the December 2003 American Society of Health- System Pharmacists Midyear Clinical Meeting in New Orleans entitled, “Dose Standardization of Oral Liquid Medications in a Pediatric Hospital.” This poster summarized extensive work done by the pharmacy department at the 235-bed pediatric tertiary care Primary Children’s Medical Center in Salt Lake City, Utah.

Traditionally, pediatric dosing of oral medications has been based on patient weight. Practice standards have not embraced standardized drug dosing, even within predetermined dosage ranges. Practitioners have multiplied the patient’s weight by the dose requirement, rounding to an appropriate number to create the final dose.

The Institute of Medicine recommends that hospitals “implement standard processes for medication doses, dose timing, and dose scales in a given patient care unit.” The Primary Children’s pharmacy hypothesized that by developing a mathematical formula allowing for weight dosing within ranges, pediatric weight-based dosing could be standardized into therapeutic dosing ranges.

The Primary Children’s Medical Center project began by tracking the number of oral medication doses prepared, and the volumes drawn into syringes each month. Usage calculations were completed assuming that 80% of the doses come from 20% of the drugs. These top 20% were plotted on a graph to find dosing patterns within a standardized therapeutic range. Dosing ranges were used to determine the mathematical equation and percentage of variation. The results allowed for exact standardized dosing and maintained dosing within therapeutic guidelines.

The Primary Children’s data showed that a monthly average of 33,348 oral doses were prepared from 147 medications. The numbers were further sorted into 127 oral liquids and 24,336 doses. Plotting the oral liquids using the 80/20 rules indicated that 25 drugs were responsible for 19,400 doses.

15% of their oral liquids had a common dosing pattern within a single dosing range that seemed acceptable to standardization. That data was formulated into a spreadsheet resulting in a common mathematical spread for standardized dosing that matched the established therapeutic dosing range The end result was that 19,000 doses were standardized into 55 standard strengths.

Taking this theory into practice increased the compliance of standardization from 15% to 84% and produced a variety of benefits. Costs were cut when workload hours decreased by 15% and drug waste dropped by 90%. While not specifically quantified, patient safety was improved by reducing volume calculation errors.

The Primary Children’s Hospital approach is somewhat revolutionary for pediatric dosing. It shows that standardized dosing requires a paradigm change in prescriptive and dispensing practice. Evidence-based data concludes that standardized dosing can be effectively implemented in pediatric

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