You don't want to become a casualty of medical error. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Dyasanoor S, Urooge A. Insight into quality of prescription writing - an instituitional study. J Clin Diagn Res. Weaver JM. It's time to throw out old-fashioned Latin abbreviations.
Anesth Prog. Velo GP, Minuz P. Medication errors: prescribing faults and prescription errors. Br J Clin Pharmacol. Sokol DK, Hettige S. Poor handwriting remains a significant problem in medicine. J R Soc Med. Thompson CA. JCAHO issues 'do-not-use' list of dangerous abbreviations. Am J Health Syst Pharm. Institute for Safe Medication Practices. List of error-prone abbreviations. October 2, Your Privacy Rights. This looks like an ordinary order for a medication.
However, if we look closely at the label for ampicillin, we notice that there are instructions about the usual dosage on the bottom right of the label. If, in this case, the person this drug is intended for is a child under 20 kg, then we will want to check this order to make sure that it is the correct amount for this particular child's weight. The doctor who wrote the order should have calculated this amount based on the child's weight, but we need to check just to be sure that this amount is safe.
We will use the information on the label and the weight of the patient to find either a recommended dosage , which is a single dosage amount that is the recommended amount for that patient, or to find a safe dosage range , which is a set of two numbers: a minimum safe dose and a maximum safe dose.
Then we will want to compare the order that has been writen by the doctor to the recommended dosage or safe range :. When a label gives us the information needed to calculate a safe range , then the ordered dosage must fall within the range i. Any dosage amount given in an order which falls outside of the range, even by a little bit, should be questioned.
When a label gives us the information needed to calculate a recommended dose , then the ordered dosage must be equal to or fairly close to the recommended dose in order to be considered safe.
If the ordered dose is not exactly the same as the recommended dose, what do we do? This is a big generalization that will not be true for many medications in the real world, but we use it just to practice this idea in a simplistic way. Remember that you should always follow the policies of a particular hospital when determining whether or not a dosage is safe.
The answer you get should be bigger than any difference between the recommended dosage and the ordered dosage. So, how do we check that? This means that the child should get mg of the drug for every kg they weigh.
So, for example, if they weighed 10 kg, they should get mg per day, and if they weighed 15 kg, they should get mg per day; however, we must be careful, because if they weight over 20 kg, they should only receive " mg to mg q.
So, if there are supposed to be four doses a day notice that the label says q. Likewise, the 15 kg child who will get mg per day should have that divided into 4 equal doses , so we should divide mg by 4 to get mg per dose. So, to check and see if the above order for "ampicillin susp. Let's suppose this child weighs 16 kg. We write down the important information below: Example: Is the following order safe for a 6 kg child? Order: Principen mg p.
We want our answer to be in mg, because our goal is to calculate the safe dosage and compare it to the given order , which measures the drug in mg. So we begin by writing:. Now we need to find something to put on the right side of the equation that will help us determine a safe dosage for this patient. Since the dosage range depends on the patient's weight, we begin by putting 6 kg to the right of the equals sign, because we need to find the number of mg we need for a 6 kg patient:.
We can put 6 kg over 1 without changing it: 6 kg 1. If we look at the label, we see that it says that the safe dosage is mg per kg per day.
Because this safe dosage is given per day , we should label our calculations "Safe dosage per day":. Now we want to get rid of the kg on the top of the right side of the equation, and we notice that we can write mg per kg as a fraction: mg 1 kg. In a safe dosage, mg and 1 kg should be equal; we can multiply our equation by mg 1 kg , because: The top of this fraction will be equal to the bottom in a safe dosage.
This fraction has kg on the bottom, which will cancel out the kg we want to get rid of on the top. None of the numbers will cancel, but we can cancel units that appear on both the top and the bottom to get:. Is the following order safe for a 43 lb child? This child has a moderate infection. Order: Kefzol mg IM q. Since the dosage range depends on the patient's weight, we begin by putting 43 lb to the right of the equals sign, because we need to find the number of mg we need for a 43 lb patient:.
We can put 43 lb over 1 without changing it: 43 lb 1. Since the patient's weight is in lb and we want to use metric as a general rule, we need to convert lb to kg. If we look at the label, we see that it says that the safe dosage is 25 to 50 mg per kg per day. We choose this concentration instead of the others listed on the label because it is the one the label says we should use when This child has a moderate infection. Because this safe dosage is given per day , we should label our calculations "Safe dosage per day", and because the safe dosage given is a range , our answer must be a range , too, with a minimum safe amount, and a maximum safe amount:.
Now we want to get rid of the kg on the top of the right side of the equation, and we notice that we can write mg per kg as two different fractions: 25 mg 1 kg and 50 mg 1 kg.
In a minimum safe dosage, 25 mg and 1 kg should be equal and in a maximum safe dosage, 50 mg and 1 kg should be equal; we can multiply our equation for the minimum by 25 mg 1 kg and our equation for the maximum by 50 mg 1 kg , because: The top of these fractions will be equal to the bottom in a safe minimum or maximum dosage. Both fractions have kg on the bottom, which will cancel out the kg we want to get rid of on the top of each equation. Now we need to get rid of the decimal in 2.
If we multiply 2. Now we notice that we can divide both 10 and 22 by 2, so we can reduce the right side of our equations by dividing 10 on the top and 22 on the bottom by The ordered amount is safe , because the ordered amount of mg is within the safe range per dose mg.
Is the following order safe for a lb child? Order: Mithracin mcg IV q. We want our answer to be in mcg, because our goal is to calculate the safe dosage and compare it to the given order , which measures the drug in mcg. Since the dosage range depends on the patient's weight, we begin by putting lb to the right of the equals sign, because we need to find the number of mcg we need for a lb patient:. We can put lb over 1 without changing it: lb 1. If we look at the label, we see that it says that the safe dosage is 25 to 30 mcg per kg per day.
Now we want to get rid of the kg on the top of the right side of the equation, and we notice that we can write mcg per kg as two different fractions: 25 mcg 1 kg and 30 mcg 1 kg.
In a minimum safe dosage, 25 mcg and 1 kg should be equal and in a maximum safe dosage, 30 mcg and 1 kg should be equal; we can multiply our equation for the minimum by 25 mcg 1 kg and our equation for the maximum by 30 mcg 1 kg , because: The top of these fractions will be equal to the bottom in a safe minimum or maximum dosage. The ordered amount is unsafe , and we should check with the physician who wrote the order and should not give the patient this dose, because the ordered amount of mcg is not within the safe range per dose mcg.
Is the following order safe for a 35 lb child? Or you may need to fill your syringe with the correct dose from the medicine vial. Either way, check the medicine label to make sure you are taking the correct medicine and the correct dose.
Also check the date on the label to make sure the medicine is not outdated. If you are filling your syringe with medicine, you will need to learn the proper technique for filling a syringe with medicine. Miller JH, Moake M. Harriet Lane Handbook.
Philadelphia, PA: Elsevier; chap 3. Medication administration. New York, NY: Pearson; chap Valentin VL. In: Dehn R, Asprey D, eds. Essential Clinical Procedures. Philadelphia, PA: Elsevier; chap Updated by: Jennifer K. Editorial team. Subcutaneous SQ injections.
A SQ injection is the best way to give yourself certain medicines, including: Insulin Blood-thinners Fertility drugs. Choose Your Injection Site. The best areas on your body to give yourself a SQ injection are: Upper arms.
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