#63: Med Recs! Two Earfuls of Medication Safety

September 14, 2022 | By Sam Masur

Summary

We go DEEP into weight based dosing of fun! Dr.  Margaret Scheffler, a board-certified pediatric intensivist who has been attending in the ICU and Pediatric Sedation Service of Hasbro Children’s Hospital since 2012, breaks down risk factors of medication errors, important considerations for pediatric prescribers (what to do about weight based dosing!), and what all providers and families should know to effectively and safely use medications.

Credits

• Producer, Writer, Infographic: Becca Raymond-Kolker, MD
• Executive Producer: Max Cruz, MD
• Showrunner: Sam Masur MD
• Cover Art: Chris Chiu MD
• Hosts: Chris Chiu MD, Justin Berk MD, Becca Raymond-Kolker MD
• Editor:Justin Berk MD; Clair Morgan of nodderly.com
• Guest: Meg Scheffler MD

Medication Safety Pearls

1. Independent risk factors for medication errors include: multiple caregivers responsible for medication dosing, alternating medication regimens, and more medicines
2. It is the provider’s job to ensure families know how to safely administer medications 
3. Pharmacists are superheroes! Use pharmacists early and often, and empower families to talk to pharmacists when they get their medications filled!
4. Elements of a prescription include: medication name, indication, route, timing, dose, volume, duration of treatment
5. Rational rounding: please round to a logical dose that a parent can draw up!

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Medication Safety Notes

Independent Risk Factors for Medication Errors:

• Alternating medication regimens (like alternating acetaminophen and ibuprofen for fever) 
• Multiple caregivers responsible for medication dosing
• The more medicines a patient is on, the more likely the provider or family is to make an error

Advice: Try to minimize exposure to unnecessary medications

Weight based dosing of fun!

• Weight based dosing should keep pediatric patients safer
• However, there should  be a weight at which children transition to adult dosing (fixed ie not weight based)
• Often, families are completely unaware that their children are receiving weight-based dosing 

It is incumbent upon providers to educate families on each element of a prescription.

What are the elements of a prescription? 

• Medication name (ie ibuprofen)
• Indication/Reason for medication (ie fever)
• Route of administration (ie By Mouth)
• Dose (ie mg)
• Volume of dose (ie ml)
• How often to take
• How long to take the medication for

Literature suggests that families are more likely to remember volumes. The evidence shows that many dosing errors are due to misunderstanding volumes. Never use vernacular (ie a teaspoon) to describe a volume of medication (kitchen spoons vary greatly!). 

Timing of Medication

• Expert opinion: The more times a day you ask someone to dose a medication, the fewer doses they will actually get. 
• If you have the choice to limit complicated regimens, you should absolutely do so. 
• AAP recommends using language such as morning, noon, evening, and bedtime for explaining medication timing to families in lieu of medical jargon such as TID or Every 8 hours. 

What should families know about medications?

• Families’ medication list for their children should be the gold standard and up to date including knowing when their child last got their medication dose.
• It is the provider’s job to ensure families know how to safely administer medications 
• Empower families to talk to pharmacists when they get their medications filled

Expert opinion: Pharmacists are superheroes! Both in inpatient and outpatient settings, pharmacists are incredible resources for pediatric providers and for families. 

What should providers know about medications?

• Communicate all aspects of a prescription (as above!) in written and verbal form
• Rational rounding: please round to a logical dose that a parent can draw up
• Discontinue medications that are outdated or are short completed courses
• Medication reconciliation constantly!
• Set expectation with  families that everyone has questions: anticipate & encourage questions

Goal

Listeners will explain the risk factors associated with medication errors, describe all parts of a medication prescription, and list key information that both families and providers need to know about safer prescribing of medications. 

Learning Objectives

After listening to this episode listeners will…  

1. Describe the basic components of a prescription
2. Be familiar with independent risk factors for medication errors
3. Utilize best practices for timing of medications in the outpatient setting
4. Learn about key information that families and providers should know about medication safety
5. Feel comfortable counseling families when prescribing new medications

Disclosures

Dr Scheffler reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Raymond-Kolker R, Scheffler M, Cruz M, Masur S, Chiu C, Berk J. “Med Recs! Two Earfuls of Medication Safety!”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ Sept 14, 2022.