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.

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.

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.

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.

Pediatric Critical Care Pharmacology

2017 ◽  
Author(s):  
Athena Zuppa
Keyword(s):  
Critical Care ◽  
Hepatic Dysfunction ◽  
Zero Order ◽  
Critically Ill Children ◽  
Pharmacokinetics And Pharmacodynamics ◽  
Basic Principles ◽  
Pediatric Critical Care ◽  
Essential Information ◽  
Zero Order Kinetics ◽  
Crucial Information

This chapter includes essential information about the basic principles of pharmacology and relates them to unique characteristics of critically ill children. The author provides a succinct summary of fundamentals of pharmacokinetics and pharmacodynamics, including absorption, distribution, metabolism, and elimination. First- and zero-order kinetics are reviewed, along with examples of drugs commonly used in the intensive care unit that follow those patterns of metabolism. The chapter also includes crucial information about how development from birth affects the various aspects of pharmacology. The effects on drug metabolism of shock, and renal and hepatic dysfunction are provided, along with drug–drug interactions, including commonly used drugs in critical care that induce or inhibit enzyme activity.

scholarly journals Recommendations on RBC Transfusions for Critically Ill Children With Nonhemorrhagic Shock From the Pediatric Critical Care Transfusion and Anemia Expertise Initiative

2018 ◽  
Vol 19 ◽  
pp. S121-S126 ◽  
Author(s):  
Jennifer A. Muszynski ◽  
Nina A. Guzzetta ◽  
Mark W. Hall ◽  
Duncan Macrae ◽  
Stacey L. Valentine ◽  
...  
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critically Ill Children ◽  
Pediatric Critical Care

Parent Stress Associated with Pediatric Critical Care Nursing: Linking Research and Practice

1991 ◽  
Vol 2 (2) ◽  
pp. 276-284 ◽  
Author(s):  
Susan Schaeffer Jay ◽  
Joanne M. Youngblut
Keyword(s):  
Critical Care ◽  
Parental Stress ◽  
Parent Stress ◽  
Critically Ill Children ◽  
Nursing Interventions ◽  
Critical Care Nursing ◽  
Pediatric Critical Care ◽  
Parent Role ◽  
Research Findings ◽  
Care Nursing

This paper connects research findings to nursing practices that may be helpful when working with stressed parents of critically ill children. Theories and concepts foundational to understanding parental stress related to pediatric critical care are reviewed. Research findings particularly associated with parent role stress are introduced, and suggestions for using these findings to design nursing interventions are presented

scholarly journals Epidemiology of Bleeding in Critically Ill Children

2021 ◽  
Vol 9 ◽  
Author(s):  
Jake Sequeira ◽  
Marianne E. Nellis ◽  
Oliver Karam
Keyword(s):  
Critical Care ◽  
Critically Ill ◽  
Critical Care Unit ◽  
Critically Ill Children ◽  
Pediatric Critical Care ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Duration Of Surgery ◽  
The Impact ◽  
Bleeding Severity

Objective: Bleeding can be a severe complication of critical illness, but its true epidemiologic impact on children has seldom been studied. Our objective is to describe the epidemiology of bleeding in critically ill children, using a validated clinical tool, as well as the hemostatic interventions and clinical outcomes associated with bleeding.Design: Prospective observational cohort study.Setting: Tertiary pediatric critical care unitPatients: All consecutive patients (1 month to 18 years of age) admitted to a tertiary pediatric critical care unitMeasurements and Main Results: Bleeding events were categorized as minimal, moderate, severe, or fatal, according to the Bleeding Assessment Scale in Critically Ill Children. We collected demographics and severity at admission, as evaluated by the Pediatric Index of Mortality. We used regression models to compare the severity of bleeding with outcomes adjusting for age, surgery, and severity. Over 12 months, 902 critically ill patients were enrolled. The median age was 64 months (IQR 17; 159), the median admission predicted risk of mortality was 0.5% (IQR 0.2; 1.4), and 24% were post-surgical. Eighteen percent of patients experienced at least one bleeding event. The highest severity of bleeding was minimal for 7.9% of patients, moderate for 5.8%, severe for 3.8%, and fatal for 0.1%. Adjusting for age, severity at admission, medical diagnosis, type of surgery, and duration of surgery, bleeding severity was independently associated with fewer ventilator-free days (p < 0.001) and fewer PICU-free days (p < 0.001). Adjusting for the same variables, bleeding severity was independently associated with an increased risk of mortality (adjusted odds ratio for each bleeding category 2.4, 95% CI 1.5; 3.7, p < 0.001).Conclusion: Our data indicate bleeding occurs in nearly one-fifth of all critically ill children, and that higher severity of bleeding was independently associated with worse clinical outcome. Further multicenter studies are required to better understand the impact of bleeding in critically ill children.

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