Frequency of emergency medicine resident dosing miscalculations treating pediatric patients

EM residents ordered a variety of IV medications [ketorolac, morphine sulfate, various antibiotics, famotidine, etomidate, ondansetron, metoclopramide, various steroid preparations, sedative medications, magnesium sulfate, diphenhydramine, ketamine, acyclovir, insulin, glucagon, lorazepam, D25W, IV fluids with potassium chloride supplement]. Patient weight Condition Medication and dosage ordered 66 kg DKA Insulin continuous infusion 3 units/h 90 kg Status asthmaticus Methylprednisolone 185 mg 16.4 kg Herpetic infection Acyclovir 820 mg 5 kg Fever/young infant Ampicillin 90 mg/cefotaxime 130 mg A complete review of all cases revealed no instance of a clinically significant adverse outcome due to medication dosing. Potential measures to decrease dosing calculation errors and ensure dosing accuracy include: ▪pharmacist to double check all IV medication order dosages prior to administration ▪protective feedback system in the electronic health record to automatically alert providers when ordered medication dosing deviates from recommended ▪verbal confirmation of accuracy in resident ordered IV medication dosing between nurse and attending physician prior to administration.