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|1||Ensure correct patient sticker on all pages of the medication chart or prescription. Write the patient name and weight on the appropriate pages.|
|2||Calculate paediatric doses based on accurate patient weight or body surface area with sensible rounding. Do not exceed adult dose.|
|3||Document mg/kg dose for ease of checking. Using a calculator, double check your calculations.|
|4||Check the dose using current, reputable references. Starship Clinical Guidelines (/for-health-professionals/starship-clinical-guidelines/), New Zealand Formulary for Children (http://nzfchildren.org.nz/), ADHB NICU Drug Protocols (for Newborns) (http://www.adhb.govt.nz/newborn/DrugProtocols/)|
|5||Give specific dosing instructions - avoid terms such as 'titrate' as much as possible.|
|6||Know the patient's current drug therapy, allergies, ADRs and potential drug interactions. Document known allergies and ADRs on the medication chart.|
|7||Use verbal orders only in exceptional circumstances. When used, verbal orders must be signed by a doctor as soon as practicable within 12 hours or as per local policy.|
|8||Cease drugs that are no longer required by putting a line through the order and sign and date it.|
|9||Take particular care when prescribing drugs with "look alike" names.|
|10||Write prescriptions clearly in indelible ink and sign the order.|
|11||Identify yourself, it's a legal requirement - write your name, registration number and sample signature in the appropriate section of the medication chart.|
|12||Prescribe legibly using capital letters.|
|13||Prescribe using generic names.|
|14||Write indication and maximum daily doses for prn medications.|
Regarding Units and Abbreviations
|15||For drug doses quoted in microgram, the word microgram should be written in full. Do not use abbreviations such as mcg and µ as they can be misread and have been associated with dosing errors.|
|16||For drug doses quoted in gram, abbreviate the word gram to 'g'. Do not use gm as it is easily confused with mg.|
|17||For drug doses quoted in units, the word units should be written in full, preceded by a space. Do not abbreviate to U as it can be misread as a zero introducing a 10-fold dosage error.|
|18||Do not abbreviate drug names as they can be easily misinterpreted eg AZT could be azathioprine, azithromycin or zidovudine.|
|19||Q.D and O.D are not appropriate abbreviations for once daily. Q.D can be misread as QID and "O" in O.D as zero or BD. Prescribe once daily as complete words.|
|20||Liquid medicines should be ordered by weight of
the active ingredients
eg amoxycillin 500 mg not amoxycillin 5 mL. Sometimes there may be good exceptions to this eg Micelle E, Vitadol C, where it may be clearer to prescribe the dose by volume. If so, be very careful and specify the concentration per mL.
|21||Always write a leading zero before a decimal point ie 0.6 mg, not .6 mg.|
|22||Never write a trailing zero after a whole number ie 8 mg, not 8.0 mg.|
|23||Leave a space between the number and unit to add clarity ie 8 mg, not 8mg.|
For Practical Reasons
|24||Round doses to the nearest whole number, where
appropriate, to minimise decimal point usage and the occurrence of
difficult to measure doses.
eg for a 50 mg/mL mixture, 250 mg instead of 260 mg may suffice.
|25||Familiarity with available products assists in
prescribing practically in whole unit size.
eg for injections: 500 mg amoxicillin (one vial) instead of 525 mg.
|26||When a liquid product is unavailable commercially as a mixture, discuss the possibility of compounding the medicine as a mixture with your ward pharmacist.|
Depending on drug solubility, some tablets may be dispersed in water so a fraction of the tablet can be taken. Check with your ward pharmacist for more information about specific products.
Modified from Royal Children's Hospital Melbourne
Did you find this information helpful?
- Date last published: 07 March 2016
- Document type: Clinical Guideline
- Services responsible: Child Health Medicines Governance Committee
- Author(s): Arti Chandra
- Review frequency: 2 years
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