HUNT MEMORIAL HOSPITAL DISTRICT           POLICY/PROCEDURE

POLICY:

The pharmacist will prepare dosing guidelines based on weight in our pediatric population. The pharmacy shall not dispense high risk mediations if the pediatric patient has not been weighed, unless it is an emergency (see High Risk policy). 

PROCEDURE:

·         Pediatric medication orders must include the patient’s current weight in kilograms.

·         Medications in automated dispensing machines (ADM) that do not undergo appropriate pharmacist review will be limited to those needed for emergency use and/or to those medications under control of a licensed independent practitioner.

·         Pharmacy will stock commercially available pediatric-specific formulations and concentration of medications whenever possible.

o    When this is not possible, the pharmacy will prepare and dispense all pediatric medications in patient-specific “unit dose” or “unit of use” containers, rather than in commercially available *adult* unit doses.

o    Adult formulations that have been repackaged for use in pediatric populations will contain a highly visible label that differentiates the medication for pediatric use.

o    Pharmacy will use oral syringes when preparing oral liquid medications for pediatric use that are to be dispensed from the pharmacy to ensure correct dosage.

§  Oral liquid doses less than 1ml will be rounded to the nearest 0.05ml (i.e. a 0.23ml dose will be rounded to 0.25ml)

§  Oral liquid doses between 1ml to 5mls will be rounded to the nearest 0.1ml.

§  Oral liquid doses over 5mls will be rounded to the nearest 0.5ml

o    Oral liquid doses will be dispensed in a dose appropriate sized oral syringe.

·         Pharmacy will maintain up-to-date pediatric reference material and provide ready access to pediatric-specific information to all hospital staff.

o    The pharmacist will provide upon request a critical care dosing sheet for all pediatric patients admitted and forward the sheet to the patient’s nurse.  (See sample Pediatric Drug Dosing Calculator)

o    The printed guidelines will remain with the patient’s medication administration record (MAR) during the entire admission.

·         Prescribers will be encouraged to include both the calculated dose and the dosing determination (i.e. mg/kg) to facilitate an independent double-check of the calculation by a pharmacist, nurse or both.

o    Exceptions to this are medications that do not lend themselves to weight-based dosing such as topicals, ophthalmics, and vitamins.

·         Pediatric patients are to have large volume IV fluids administered through a buretrol to minimize the possibility of fluid overload in the event of pump and/or clamp failure.

·         Large volume IV fluids are limited to a maximum of 1000ml volume.

·         Medication administered by the IV piggyback rout will be administered through a large volume IV line with carrier fluid.