ࡱ> `c_ $bjbj G3l l sss4h$34"?ggggg#$#$#$>>>>>>>$@CJ>s0&#"#|0&0&>gg >|)|)|)0&d8gRg>|)0&>|)|)E:Q"%>gjF&M=h>>0"?=pC'0C%>%>Cs9>T#$v$T|)$D1%#$#$#$>>L(0#$#$#$"?0&0&0&0&C#$#$#$#$#$#$#$#$#$l u:  5 October, 2009 Beth Loe National Co-ordinator DHBNZ Safe and Quality Use of Medicines Group Medicines Group (SQM group) Waitemata District Health Board Shea Terrace Private Bag 93 503 Takapuna Auckland Dear Beth, Re: proposed alert on Paediatric Prescribing This case highlights a number of important issues regarding paediatric prescribing. In summary, a four week old infant, birth weight 2.74kg, was admitted to a paediatric ward in New Zealand with the weight recorded on admission being 6.82kg (this weight is greater than the 97th percentile for age). The weight of 6.82kg was used for all fluid and medications that the infant received until six days later when the infant was weighed again and found to be 3.7kg. The alert results from the Health and Disability Commissioners report into the above case and needs to be widely distributed to all health professionals who assess, prescribe, dispense and administer medications to children, including midwives, as there is an opportunity for wider culture change in society where parents talk about weight of babies in metric and not imperial measurements. As a result of you bringing this to our attention the Paediatric Society of New Zealand, via their Pharmacists and Therapeutics Special Interest Group, will ask Pharmac, at the next Telepaediatrics meeting (21st October), to include growth charts in the New Zealand Pharmaceutical Schedule. Access to growth charts in the New Zealand Pharmaceutical Schedule will provide community pharmacists with an appropriate and accessible reference. The Paediatric Society, again via their Pharmacists and Therapeutics Special Interest Group, will ask the Pharmaceutical Society of New Zealand to make a recommendation to the Ministry of Health that all community pharmacies have access to an appropriate paediatric pharmacopoeia. Access to a paediatric pharmacopoeia will ensure that community pharmacists are able to confirm appropriate dosing. Specific points concerning your recommendations from the Paediatric Society are as follows: Weigh and record weight only in kilograms We agree with this statement. If possible use scales that measure only in kilogram Change the wording of this to Only use scales that measure in kilograms, or have imperial measurements disabled, for weighing patients. This is a key action point in preventing further errors like the one described. Unfortunately it was not possible to determine if the error in the case was the result of a misinterpretation of the weight in pounds as being that in kilograms, however this remains a possibility and is an area that has been highlighted as a risk for future errors. Scales that just measure in kilograms are available. For example, in Waikato Hospital all scales in the Paediatric areas, Emergency department and outlying wards where children are routinely admitted, measure only in metric. This should be the standard for other such areas in the country. Indeed, all scales used for weighing children in any health service, or by any health professional, or any provider working under contract to the Ministry of Health or a District Health Board, must be calibrated in metric and any facility for imperial measurements must be disabled. This is about changing the culture of talking about the weight of babies in pounds. Write weight in kilogram on every paediatric prescription written Change the wording to Write weight in kilograms and the date this was established on every paediatric prescription, medication chart, or other documents where weight is used to calculate treatments e.g. fluid charts. In order to allow health practitioners who dispense and administer medications the ability to assess if the appropriate weight was used to calculate a medication dose they should know when that weight was established. In hospital a percentile chart should always be attached to the medicine chart to record the weight and allow comparison with the expected weight for age Unfortunately the infant in question was in hospital for six days before the error was recognised. Obviously recommendations need to allow for transcription errors (again a possibility in this case) to be realised in a timely manner when documenting patients weights that are subsequently going to be used for prescribing of fluids and medications. We suggest changing the wording to Weight percentile should be recorded on all hospital medication charts and other documents where weight is used to calculate treatments e.g. fluid charts. The attachment of individual percentile charts is both costly and cumbersome. The providing of a percentile on the chart allows for an easy check of is the weight appropriate for age. A further bullet point should be added, Health professionals should confirm that the appropriate weight is being used at the time of prescription, dispensing or administration. For ward nurses who tend to always administer medications and fluids in pairs this would involve a mental check of Is the charted weight appropriate for this patient. Likewise a similar process should be expected of health professionals who prescribe medications and fluids in hospital. For hospital pharmacists this may involve confirming that the percentile recorded on the chart is correct for the weight recorded. In the community always compare measured weight with that expected for age i.e. percentile chart Change the wording to Weight percentiles should be checked by community pharmacists prior to dispensing medications for all children aged less than 13 years. Age or date of birth is documented on community scripts for those aged less than 13 years. If weight was to be recorded as suggested above pharmacists could simply check against percentile charts published in the New Zealand Pharmaceutical Schedule. A number of children have weights that are above the 97th percentile. However this could be checked as being the correct weight by confirming this with the caregiver. Ensure that the weight based dose does not exceed the recommended adult dose - We agree with this statement Use an appropriate paediatric text when dosing for children Change the wording to Always use an appropriate paediatric pharmacopoeia when prescribing, dispensing or administering medications to children. Use local guidelines when dosing for obese children - We agree with this statement. Some medications should be dosed on lean body weight rather than total bodyweight e.g. aminoglycosides and some medications should be dosed as mg/m2 e.g. cytotoxics We changing the wording to Some medications should be dosed on lean body weight, mg/m2 or age. Medication safety committees should include a practitioner who is aware of paediatric issues - We agree with this statement. We suggest adding the following bullet point; All scales need to be zeroed prior to each use and calibrated regularly according to manufacturers recommendations. Thank you for allowing us the opportunities to comment on these recommendations. Yours sincerely,  Dr Rosemary Marks President of the Paediatric Society of New Zealand     THE PAEDIATRIC SOCIETY OF NEW ZEALAND Secretariat: Email:Denise Tringham P O Box 22 234 Wellington 6441 Tel: (04) 938 4827 Fax: (04) 976 4827 psnz@paradise.net.nz  Health of our children: Wealth of our nation  " < 8 :  *5STUde*+MRG^˦˜˗y˦h-h}6h-hJ5\h(Sh-hJ\ h-\hJB*\ph hJ5\ hJ6\ h}6h}hJ6 h(S6 hJ6 hJ\ hJH*hJ5;aJ hJaJhJaJmH sH  hJaJhJh-h$G,4b~ f g  gd(SgdJ TU+pqn !!gd(S d*$gd(S$ d*$a$gd}$ d*$^a$gd} d*$^gd(S & F# d*$gd(Sopq!*Dmn 0 !!!!!!!!"" "½¹ͱޓxhJ5H*\hJ6H*\h}6\mH sH h}hJ6\mH sH h}h}6h}hJ6h}hJ\h} hJH*hJ h}6\h}hJ6\ hJ5\ hJ\ hJ6\h}\mH sH h}hJ\mH sH -! 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" Oh+'0p   , 8 DPX`h TAX INVOICEracp Normal.dotmT7Microsoft Office Word@e@`uC@.F@00JF)՜.+,0 hp  racp2  TAX INVOICE Title  !"#%&'()*+-./0123456789:;<=>?@ABCDEFGHIJKLMNPQRSTUVXYZ[\]^abeRoot Entry FpEjFdData $1Table,fDWordDocument GSummaryInformation(ODocumentSummaryInformation8WMsoDataStoreKujFjFQFI0U0FAZAQ==2KujFjFItem  PropertiesUCompObj y   F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q Paediatric Society of New Zealand: Submissions
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The Paediatric Society believes all children and youth should, by right, attain optimal physical, mental and social health and wellbeing.  By working as a coordinated national network of health professionals the Society dedicates its efforts and resources to making official submissions to both Government and Non-Government organisations on issues that will impact on the health and wellbeing of children and young people.

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