August 15, 2012 - Medication errors are among the most common and preventable causes of harm to pediatric patients. Often, these errors are related to incorrect dosing because pediatric medication doses are weight-based, unlike the standard dosing units used for adult patients, and the recommended dosages given in terms of kilograms. But children are still weighed on scales that read in pounds or kilograms. A 2009 study revealed that more than one in four medication errors involving wrong patient weights were due to confusion between pounds and kilograms. Based on this and other evidence related to medication errors, and a significant body of research supporting weighing pediatric patients in kilograms, the Emergency Nurses Association (ENA) has developed and released a position statement supporting this practice.
The American College of Emergency Physicians, the American Academy of Pediatrics and the Institute for Safe Medicine Practices have all endorsed ENA’s position statement.
The position statement, Weighing Pediatric Patients in Kilograms, recommends several practices to ensure that pediatric patients’ weights are consistently measured and recorded in kilograms, including:
- Scales used to weigh pediatric patients only be configured to record weights in kilograms.
- Pediatric weights are recorded in a prominent place on the medical record.
- Electronic medical records are standardized to allow only kilograms for pediatric weight entries.
- The pediatric patient’s actual weight is considered part of the mandatory nursing assessment unless they require resuscitation or emergent stabilization.
- For the pediatric patient who requires resuscitation or emergent stabilization, a standard method of estimating weight in kilograms is used (e.g., length-based system).
- The pediatric patient’s weight in kilograms is included in any inter- or intra-disciplinary patient handoff report.
“Medication errors are always serious, but in the emergency department, and with infants and children, they can have particularly serious consequences,” said Gail Lenehan, EdD, MSN, RN, FAEN, FAAN, president of ENA. “Determining the correct dose of a pediatric medication typically requires multiple calculations, and is challenging enough. The need to additionally convert pounds adds to the confusion, which can result in serious, even fatal medication errors. This is a serious, even deadly problem, with a very easy solution: weighing pediatric patients only in kilos. In some emergency departments, parents who ask for the child’s weight are given it in kilograms and simply referred to a conversion chart, so that pounds aren’t even mentioned."
"Ensuring that correct weight information is recorded in the emergency department is particularly important because recording errors made in the emergency department can be passed on to other inpatient units and possibly perpetuated throughout a patients’ stay," Lenehan continued. "A consistent standard for recording weight can go a long way in helping us avoid dangerous medication errors and provide better and safer patient care. The endorsements by these key organizations underscore the benefits of this practice and support encouraging all hospitals to adopt it.”
Source: Emergency Nurses Association.