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In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
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Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
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Gentamicin, an aminoglycoside antibiotic, is commonly administered via intermittent intravenous infusion to treat severe infections. An intermittent one-hour infusion of gentamicin, administered at eight-hour intervals, allows for precise control of plasma drug concentrations, minimizing toxicity while ensuring therapeutic efficacy. Pharmacokinetic principles govern the dynamics of plasma concentrations and can be mathematically described using specific equations.The plasma drug concentration...
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The development of extended-release formulations has facilitated the transition from intravenous to oral medication, offering a more convenient and patient-friendly approach to drug administration. This transition, however, requires careful management to ensure that therapeutic drug levels are maintained, preserving efficacy and avoiding adverse effects. Understanding pharmacokinetic principles and dosage calculations is critical during this process.Pharmacokinetics of the...
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Implementation of standardized pediatric i.v. medication concentrations.

Kara L Murray1, Dahna Wright2, Bill Laxton2

  • 1Kara L. Murray, Pharm.D., BCPS, is Manager, Clinical Therapeutics and Pharmacy, Clinical Services Group; Dahna Wright, B.S.N., RN, is Director, Women's and Children's Clinical Services; Bill Laxton, B.S.N., RN, CPHRM, is Director, Risk and Patient Safety; Karla M. Miller, Pharm.D., BCPP, is Assistant Vice President, Pharmacy Services and Clinical Therapeutics; Janet Meyers, B.S.N., RN, M.B.A., is Assistant Vice President, Women's and Children's Services; and Jane Englebright, PH.D., B.S.N., RN, CENP, is Chief Nursing Officer and Vice-President, Clinical Services Group, Hospital Corporation of America, Nashville, TN. kara.murray@hcahealthcare.com.

American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists
|August 23, 2014
PubMed
Summary

Standardizing pediatric intravenous (IV) medication concentrations across a large healthcare system improved safety. A financial incentive motivated 97% of facilities to adopt the new standard list, enhancing medication safety.

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Area of Science:

  • Healthcare Administration
  • Patient Safety
  • Pharmacology

Background:

  • Previous independent standardization of drug concentrations led to system-wide variations.
  • These variations complicated electronic health record integration and provider mobility.
  • A need existed for a unified approach to pediatric intravenous medication safety.

Purpose of the Study:

  • To describe the development and implementation of a standardized list of pediatric intravenous medication concentrations.
  • To address inconsistencies in medication prescribing and enhance patient safety across a large healthcare system.

Main Methods:

  • A multidisciplinary team developed a comprehensive standard list of 119 pediatric IV medications and 372 concentrations.
  • Implementation was incentivized through a malpractice insurance credit program.
  • Facilities were required to approve the list, update pharmacy dictionaries, and configure smart pump software.

Main Results:

  • 141 out of 145 (97%) eligible facilities successfully implemented the standard pediatric IV medication concentrations.
  • Facilities received a 2% credit towards malpractice insurance costs upon completion.
  • The initiative successfully drove system-wide standardization.

Conclusions:

  • A financial incentive strategy, specifically a malpractice insurance credit, was effective in motivating the adoption of standardized pediatric medication concentrations.
  • This standardization is crucial for improving patient safety and operational efficiency in large healthcare systems.