Wednesday, 7 August 2013

How accurate are the doses of medicines given to children?

An interesting letter in Archives of Disease in Childhood published online ahead of print publication goes some way to answering that very question, and the answer is, in many cases not very.

An audit of children's wards at two hospitals in England looked at the doses of liquid medicines that were prescribed, and how easy these were to give using the syringes available on the ward.  For example, one 1.48 mg dose of morphine which came in a concentration of 10 mg/mL should have been 1.48 mL - a dose that was not possible to give accurately with either a 1 mL or 2.5 mL syringe, requiring either rounding up/down, or the use of two syringes.

Across all of the drugs given 34% of antimicrobials, 25% of analgesics; 11% of steroids and 5% of sedatives were not accurately measurable using the syringes available.  This leads to two issues:
  1. The technical issue of whether an unmeasurable dose that is rounded up/down, and so which is  not really correct, is a prescribed wrongly or administered wrongly.  In crude terms 'whose fault is it?' (in a no blame, new open NHS kind of way).
  2. Secondly, and of course much more important, is does it matter?  That depends on many things, the child; the dose; the amount of the rounding; other medicines that the child may be on....the list could go on and on.  Also when rounding up, do you round up to the line on the syringe, go half way through it, or go to the top of the line?
The other interesting thing that the authors speculate on is if it is like this in hospital, what might be going on in homes?   To this I would add the issue of crushed tablets; never recommended but it probably still goes on.

Does it matter?  Probably not in most cases, but the authors do conclude that research into the clinical implications of this would be helpful.  Probably the most important thing is not the variation per se, but the judgement of those giving the medicines.  The dangerous people are those who don't know what they don't know.

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