Medication Safety in Children: Beyond "The Five Rights"
- Kimberly Kostas
- Jan 29, 2021
- 3 min read
In Nursing School, many nurses are taught "The Five Rights" when learning to administer medication safely:
The RIGHT Medication
The RIGHT Patient
The RIGHT Dose
The RIGHT Route
The RIGHT Time
Although these "Rights" are essential, there is a big "Wrong" that can be the route of medication errors in children specifically: The WRONG weight.
Unlike the adult world, where most medications have a standard adult dose, medications prescribed for children are mostly weight-based. This means that the smaller the child, the smaller the medication dose. Medications are not typically ordered in standard ranges, but instead in milligrams per kilograms. Safe dosing must be considered by the doctor ordering the medication, the pharmacy preparing the medication, and the nurse administering the medication.
Having the wrong weight in a chart may not necessarily be the fault of the person ordering, dispensing, or giving a medication. Therefore it should be looked at very closely every time a medication is ordered, dispensed, and administered.
In non-emergency situations, a weight is typically obtained when checking into a hospital or clinic. Kilograms is the most widely accepted way to obtain a weight in the pediatric population. In 2012, the Emergency Nurse Association released a statement, endorsed by the American Academy of Pediatrics, recommending all children in the emergency department be weighed in kilograms.
Many scales in medical settings have the ability to read in both kilograms and pounds. There are facilities that only allow scales to weigh patients in kilograms, which in my opinion, is the safest option. A scale that reads both ways is an error waiting to happen. A busy nurse or assistant may accidently document a weight in pounds instead of kilograms.
To put this into perspective for all the non-medical folks, 1 kilogram = 2.2 pounds. This means that if a child weighs 30 pounds, and this is accidently documented as kilograms, everyone will be under the impression this child weighs 66 pounds. This means the child will get over double the recommended dose of a medication when calculating mg/kg using the documented weight.
Another example that is common in the pediatric world is when you get a child who absolutely will not stay on a scale to be weighed, no matter what tricks you have up your sleeve. In this case, a nurse or assistant may receive an estimate weight in pounds from a parent. Most parents will not be giving out their child's weight in kilograms, so this must be calculated by the person documenting the weight. The calculation may be done incorrectly, or they may get busy and accidently document the weight in pounds as kilograms.
So what can both healthcare providers and caregivers do to ensure this mistake does not happen?
In terms of healthcare providers, you must become diligent about paying close attention to the documented weight. Do not just assume it is correct. I always made it a habit to look at my patient's weight in the chart when I met them, and see if it visually made sense when I physically saw them. If I had any question, I would reweigh my patient. As frustrating as this extra step can be during a busy shift, it's sure better than a child getting the wrong dosage of medication and potentially being harmed by this. I have caught many incorrect weights by incorporating this unofficial safety check into my daily routine. I would say this is just as important as implementing "the five rights".
Parents, you can also play a role in making sure your child's weight is correct by simply asking the medical worker to let you know what the weight is. Take the weight in kilograms and multiply it by 2.2 on your phone's calculator. If it doesn't come close to your child's last known weight, SPEAK UP! Vice versa, if they give you a weight in pounds, ask them if they document it in kilograms and how many kilograms that is. Again, get your phone calculator out and double check the numbers. If the weight is in pounds, divide it by 2.2 and that is what it should be in kilograms. It could literally save your child's life. A lot of parents don't want to question medical staff, but honestly, please do. As uncomfortable as it may be, you are helping both your child stay safe and the medical staff take good care of your child.
Luckily there have been many safety measures across healthcare systems to decrease weight errors including kilogram-only scales, double checks with other staff, computer system flags, weight conversion charts, etc. That being said, the world is not perfect and there are medical facilities that still need to catch up with these safety measures. Also, humans are humans and they make mistakes. This is reality.
DO YOUR PART AND ALWAYS DOUBLE CHECK!
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