Medication Dosages During Pediatric Emergencies: A Simple and Comprehensive Guide

PEDIATRICS ◽  
1989 ◽  
Vol 84 (4) ◽  
pp. 731-735
Author(s):  
CRAIG TENDLER ◽  
SUSAN GROSSMAN ◽  
JUDITH TENENBAUM
Keyword(s):  
Critical Care ◽  
Pediatric Critical Care ◽  
Drug Dosing ◽  
Pediatric Emergencies ◽  
Medical Centers ◽  
Limited Experience ◽  
Life Threatening ◽  
Drug Doses

Drug dosing during life-threatening pediatric emergencies is a source of stress for most physicians and nurses. This can be attributed to the lack of standardized drug doses for most pediatric medications, thus requiring time-consuming calculations with small margins of error. Anxiety may be further heightened by the infrequent occurrence of pediatric emergencies, resulting in a staffs limited experience with such crises. In an effort to reduce the potential for error and anxiety during administration of these pediatric critical care drugs, a majority of the major medical centers are currently using medication tables. Many prototypes have been published in the literature, but most require calculations and are incomplete in their content.

scholarly journals DYSNATREMIAS;

2017 ◽  
Vol 24 (07) ◽  
pp. 1076-1080
Author(s):  
Riffat Omer ◽  
Muhammad Khalid Masood ◽  
Saima Asghar ◽  
Muhammad Jawad ◽  
Amir Afzal ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Serum Sodium ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Pediatric Critical Care ◽  
Life Threatening ◽  
Study Setting ◽  
Critical Care Patients

Dysnatremias (hyponatremia and hypernatremia) are common electrolytedisorders encountered in pediatric critical care patients. The spectrum of both hypo- andhypernatremia varies from mild to severe, being life threatening occasionally. We carried outa study to determine the etiology, epidemiology and effect of dysnatremias on outcomes ofpediatric critical care patients. Objectives: To determine the etiology, epidemiology and effectof dysnatremias on outcomes of pediatric critical care patients. Study Design: Prospective,observational study. Setting: Paediatric Intensive Care Unit (PICU) Services Hospital Lahore.Period: October 2014 to March 2015. Results: 185 patients were included. 19 (10.3%) patientshad hyponatremia and 22 (11.9%) patients had hypernatremia. A weak but significant inverserelationship between presentation serum sodium and mortality was observed (r = - 0.39,n=185, p= <0.001, two-tailed). Conclusions: Presentation serum sodium may influence theoutcomes of the patients admitted to the pediatric intensive care unit.

Do Infants Less than 12 Months of Age with an Apparent Life-Threatening Event Need Transport to a Pediatric Critical Care Center?

2013 ◽  
Vol 17 (3) ◽  
pp. 304-311 ◽  
Author(s):  
Amy H. Kaji ◽  
Genevieve Santillanes ◽  
Ilene Claudius ◽  
Manoj K. Mittal ◽  
Katie Hayes ◽  
...  
Keyword(s):  
Critical Care ◽  
Care Center ◽  
Pediatric Critical Care ◽  
Life Threatening ◽  
Life Threatening Event

scholarly journals A modified Delphi to define drug dosing errors in pediatric critical care

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Nadia Roumeliotis ◽  
Eleanor Pullenayegum ◽  
Paula Rochon ◽  
Anna Taddio ◽  
Chris Parshuram
Keyword(s):  
Critical Care ◽  
Reference Range ◽  
Error Threshold ◽  
Critically Ill Children ◽  
Pediatric Critical Care ◽  
Drug Dosing ◽  
Modified Delphi ◽  
Dosing Error ◽  
Clinical Scenarios ◽  
Definition Of

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.

Pediatric critical care nurses' knowledge of cardiac dysrhythmias

1993 ◽  
Vol 2 (5) ◽  
pp. 378-384 ◽  
Author(s):  
AM Pettinger ◽  
SL Woods ◽  
SP Herndon
Keyword(s):  
Critical Care ◽  
Life Support ◽  
American Association ◽  
Demographic Variables ◽  
Critical Care Nurses ◽  
Knowledge Level ◽  
Pediatric Critical Care ◽  
Life Threatening ◽  
Total Test ◽  
Nurses Knowledge

OBJECTIVE: To describe pediatric critical care nurses' knowledge of dysrhythmias in critically ill pediatric patients and relate this knowledge level to certain demographic variables (education, nursing experience, certification, supplemental training, area of employment and geographic region of residence). DESIGN: A descriptive survey. SETTING: American Association of Critical-Care Nurses' 19 geographic regions of the United States. PARTICIPANTS: Of 1000 questionnaires mailed to pediatric critical care nurses who were members of the American Association of Critical-Care Nurses in 1991, 356 responses were received (a response rate of 36%). INTERVENTION: A criterion-referenced, self-administered test regarding pediatric dysrhythmias and a demographic sheet randomly mailed to 1000 pediatric critical care nurses. Test results were analyzed and compared with demographic variables. RESULTS: The mean total test score was 66%. Significantly higher total test scores and selected subtest scores were demonstrated in relationship to the following variables: increased age; certification in pediatric advanced life support, advanced cardiac life support or adult critical care; increased years of adult critical care experience; advanced dysrhythmia courses and dysrhythmia self-study; and perceived knowledge level above that of the advanced beginner. CONCLUSIONS: Pediatric critical care nurses' overall knowledge of dysrhythmias was low. Knowledge strengths included recognition of basic and life-threatening dysrhythmias and calculation of basic ECG measurements. Knowledge deficits included importance of sinus bradycardia in the neonate, appropriate intervention for life-threatening dysrhythmias and calculation of an irregular heart rate. These deficits should be considered when planning continuing education programs for pediatric critical care nurses.

scholarly journals A Modified Delphi to Define Drug Dosing Errors in Pediatric Critical Care

2020 ◽  
Author(s):  
Nadia Roumeliotis ◽  
Eleanor Pullenayegum ◽  
Paula Rochon ◽  
Anna Taddio ◽  
Chris Parshuram
Keyword(s):  
Critical Care ◽  
Reference Range ◽  
Error Threshold ◽  
Critically Ill Children ◽  
Pediatric Critical Care ◽  
Drug Dosing ◽  
Modified Delphi ◽  
Dosing Error ◽  
Clinical Scenarios ◽  
Definition Of

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.

scholarly journals A Modified Delphi to Define Drug Dosing Errors in Pediatric Critical Care

2020 ◽  
Author(s):  
Nadia Roumeliotis ◽  
Eleanor Pullenayegum ◽  
Paula Rochon ◽  
Anna Taddio ◽  
Chris Parshuram
Keyword(s):  
Critical Care ◽  
Reference Range ◽  
Critically Ill Children ◽  
Target Range ◽  
Pediatric Critical Care ◽  
Drug Dosing ◽  
Modified Delphi ◽  
Dosing Error ◽  
Clinical Scenarios ◽  
Definition Of

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.MethodsWe 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 dosing principles and error thresholds, as defined by proportion above and below reference range, for common PICU medications and clinical scenarios. ResultsForty-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. Expert clinicians agreed, for most medication categories and clinical scenarios, that dosing over or below 10% of reference range was considered an error threshold.ConclusionExpert clinicians in the PICU agree that, for most intermittent medications and clinical scenarios, dosing over 10% below or above reference range is considered a dosing error.The threshold may be larger for non-toxic medications, and narrower for very toxic medications. This consensus driven definition will help guide routine clinical dosing practice, standardized reporting and drug quality improvement in pediatric critical care.

The Association of Pediatric Critical Care Medicine Training Programs with Research Publication Productivity and Employment Outcomes of Their Graduates

2020 ◽  
Author(s):  
Sonali Basu ◽  
Robin Horak ◽  
Murray M. Pollack
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Medical School ◽  
Training Programs ◽  
Fellowship Training ◽  
Publication Productivity ◽  
Research Publication ◽  
Pediatric Critical Care ◽  
Publication Success ◽  
Fellowship Programs

AbstractOur objective was to associate characteristics of pediatric critical care medicine (PCCM) fellowship training programs with career outcomes of PCCM physicians, including research publication productivity and employment characteristics. This is a descriptive study using publicly available data from 2557 PCCM physicians from the National Provider Index registry. We analyzed data on a systematic sample of 690 PCCM physicians representing 62 fellowship programs. There was substantial diversity in the characteristics of fellowship training programs in terms of fellowship size, intensive care unit (ICU) bed numbers, age of program, location, research rank of affiliated medical school, and academic metrics based on publication productivity of their graduates standardized over time. The clinical and academic attributes of fellowship training programs were associated with publication success and characteristics of their graduates' employment hospital. Programs with greater publication rate per graduate had more ICU beds and were associated with higher ranked medical schools. At the physician level, training program attributes including larger size, older program, and higher academic metrics were associated with graduates with greater publication productivity. There were varied characteristics of current employment hospitals, with graduates from larger, more academic fellowship training programs more likely to work in larger pediatric intensive care units (24 [interquartile range, IQR: 16–35] vs. 19 [IQR: 12–24] beds; p < 0.001), freestanding children's hospitals (52.6 vs. 26.3%; p < 0.001), hospitals with fellowship programs (57.3 vs. 40.3%; p = 0.01), and higher affiliated medical school research ranks (35.5 [IQR: 14–72] vs. 62 [IQR: 32, unranked]; p < 0.001). Large programs with higher academic metrics train physicians with greater publication success (H index 3 [IQR: 1–7] vs. 2 [IQR: 0–6]; p < 0.001) and greater likelihood of working in large academic centers. These associations may guide prospective trainees as they choose training programs that may foster their career values.

Adverse Events Reporting System as Experienced by Critical-Care Nurses in KwaZulu-Natal, South Africa

2018 ◽  
Vol 20 (1) ◽  
Author(s):  
Thusile Mabel Gqaleni ◽  
Busisiwe Rosemary Bhengu
Keyword(s):  
South Africa ◽  
Critical Care ◽  
Adverse Events ◽  
Patient Care ◽  
Family Involvement ◽  
Reporting System ◽  
Legal Framework ◽  
Critical Care Nurses ◽  
Kwazulu Natal ◽  
Life Threatening

Critically ill patients admitted to critical-care units (CCUs) might have life-threatening or potentially life-threatening problems. Adverse events (AEs) occur frequently in CCUs, resulting in compromised quality of patient care. This study explores the experiences of critical-care nurses (CCNs) in relation to how the reported AEs were analysed and handled in CCUs. The study was conducted in the CCUs of five purposively selected hospitals in KwaZulu-Natal, South Africa. A descriptive qualitative design was used to obtain data through in-depth interviews from a purposive sample of five unit managers working in the CCUs to provide a deeper meaning of their experiences. This study was a part of a bigger study using a mixed-methods approach. The recorded qualitative data were analysed using Tesch’s content analysis. The main categories of information that emerged during the data analysis were (i) the existence of an AE reporting system, (ii) the occurrence of AEs, (iii) the promotion of and barriers to AE reporting, and (iv) the handling of AEs. The findings demonstrated that there were major gaps that affected the maximum utilisation of the reporting system. In addition, even though the system existed in other institutions, it was not utilised at all, hence affecting quality patient care. The following are recommended: (1) a non-punitive and non-confrontational system should be promoted, and (2) an organisational culture should be encouraged where support structures are formed within institutions, which consist of a legal framework, patient and family involvement, effective AE feedback, and education and training of staff.

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