Pediatrics
Elizabeth Briand
When it comes to dispensing medications for infants and children, even the smallest of miscalculations could have potentially serious consequences. Traditionally, though, one piece of information—the weight of pediatric patients—has not been provided by prescribers, leaving it up to pharmacists to check weights or provide safe dosing guidelines for parents and caregivers.
Providing weight “hasn’t been the standard of practice,” said Sarah Oprinovich, PharmD, from the University of Missouri-Kansas City School of Pharmacy.
Oprinovich coauthored a study on pediatric weight-based antibiotic dosing published last year in JAPhA. The study found that of 115 prescriptions evaluated, 45 were missing a patient’s weight, diagnosis code, or both, and of the remaining 70 considered optimal—defined as including patient weight and diagnosis code—42 were prescribed outside of guideline-recommended dosing, with low dosing the most common result.
“The data sent to the pharmacy are the least amount of data necessary,” said Jake Galdo, PharmD, managing network facilitator for CPESN Health Equity. “Some management systems have no ability to document the weight of a child. Others do.”
While conducting the study, Oprinovich and her fellow researchers discovered that software parameters played a significant role in the absence of a patient’s weight.
“It has to do with settings in e-prescribing [systems at] the pharmacy receiving the prescription,” said Oprinovich. “When we ran the reports to see where weights were included, we found that they were being transferred [to the pharmacist] in the background of files, usually with the vitals. They were there; they just weren’t in a conspicuous spot.”
The value of knowing weights
Patient weight is of greater concern with certain medications. These include baclofen, especially in an oral suspension, or any other medications that can possibly be compounded, according to Brenda Denson, PharmD, pharmacy educator at Children’s of Alabama.
“There are so many strengths of compounded medications. The weight [of a patient] is so important in checking the accuracy of the doses,” said Denson.
Some medications, according to Denson, should not be dispensed at all without knowing the patient’s weight. These include sedating agents, medications with muscle relaxing potential, and some medications for seizures.
“There are some medications [for which] it’s really important to know the weight, like heart failure medications, and those are going to get your attention,” said Oprinovich. “You’ll spend a bit more time on medications like that. You’ll be more likely to call and check the weight, but that takes extra time. Having the weight [in hand] would save all of that.”
Weight can also play an important role in how well antibiotics work. Underdosing can often lead to decreased effectiveness of antibiotics.
“If [the child] is on their third antibiotic, that means it didn’t treat it,” said Galdo, who is also CEO of Seguridad, which produces safety scorecards for community pharmacies.
Tracking down the details
Galdo suggests that pharmacists actively pursue getting a child’s weight. “I’m a health care provider and can have a scale in my pharmacy and collect weight,” he said. “When someone comes in to get a kid’s prescription, I’ll ask them if they know their child’s weight. If they don’t, then I’ll say this dose is between weights of this and that, so please check when you get home. ‘If [they’re] not between those weights, then please call me.’ ”
But many pharmacists, especially in community practice, may not have the ability to get a child’s weight.
Ultimately, the creation of software systems that would make it easier to see embedded data such as weight could save pharmacists time and ensure accuracy.
If weights were easier to access, it would take pharmacists less time to verify dosing. “It needs to be an easy system—you don’t want to have to click five screens to get the information,” said Oprinovich. “You just want it to be available.”
Having weight and other key details in hand could be important factors in safety as well as quality. “Our minimum standard is to make sure it’s the right dose and equip ourselves to make that happen,” said Galdo. ■