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Published on: June 11, 2012
Opioid Dosing Deviation and Dose Banding Development in Young Hospitalized Children
Karina G Phang1, Amy E Wahlquist2, Genevieve Hayes3
1Geisinger, Department of Pediatrics, Center for Pharmacy Innovations and Outcomes, Danville, Pennsylvania.
Insights
Twenty percent of pediatric opioid doses fall outside recommended ranges, increasing risks. Dose banding can simplify prescribing and reduce errors in children.
Area of Science:
- Pediatric pharmacology
- Patient safety
- Medication management
Background:
- Individualized, weight-based opioid dosing in children presents safety concerns and process inefficiencies.
- Dose banding, a patient safety strategy, standardizes doses by weight ranges to minimize dosing errors.
Purpose of the Study:
- To assess the frequency of dosing deviations for common intravenous (IV) and oral opioids in hospitalized children.
- To analyze how dosing deviations differ across pediatric age groups.
- To evaluate the potential reduction in dose variation achievable through dose banding.
Main Methods:
- A cross-sectional analysis of 3361 opioid doses administered to hospitalized children aged 2 months to 24 months.
- Categorization of dosing deviations: within ±5% (no deviation), >5% below (negative), and >5% above (positive) reference ranges.
- Descriptive and bivariate statistical analyses were employed.
Main Results:
- 79.2% of doses were within the reference range, while 6.3% were below and 14.4% were above.
- Dosing deviations varied by age: more frequent in younger children for oral opioids and in older children for IV morphine.
- Dose banding could potentially decrease unique prescribed doses by 75% and eliminate unintended deviations.
Conclusions:
- Approximately 20% of opioid doses for children up to 24 months fall outside recommended therapeutic ranges.
- Dose banding shows promise as a strategy to simplify opioid prescribing and enhance safety in pediatric inpatient settings.
Background And Objectives:
Individualized, weight-based opioid dosing poses safety risks and contributes to inefficient medication delivery processes. Dose banding is a patient safety strategy to reduce dosing errors through standardized doses based on weight ranges. Study objectives were (1) determine the frequency of dosing deviation from reference ranges of common intravenous (IV) and oral opioid medications, (2) evaluate the differences in dosing deviations by age, and (3) determine the potential reduction in dose variation that could be achieved by dose banding.
Methods:
We conducted a cross-sectional analysis of hospitalized children ≥2 months to ≤24 months old who received IV morphine, oral methadone, or oral oxycodone at a single center. Dosing was categorized as no dosing deviation (within ±5% of the reference range), negative dosing deviation (>5% below the reference range), or positive dosing deviation (>5% above the reference range). Descriptive and bivariate analyses were conducted.
Results:
A total of 3361 opioid doses met the inclusion criteria. A total of 2663 (79.2%) had no dosing deviation, 214 (6.3%) demonstrated negative deviations, and 484 (14.4%) demonstrated positive deviations. Dosing deviations were more frequent among subjects ≥2 months to ≤6 months old for oral methadone and oxycodone (P < .0001) and more frequent among older age group for IV morphine (P < .0001). Dose banding has the potential to reduce the number of unique doses prescribed for all medications by 75% while eliminating unintended dosing deviations.
Conclusions:
A total of 20% of opioid doses prescribed to children ≤24 months of age are outside the recommended ranges. Dose banding represents a promising method for simplifying opioid prescribing in the pediatric inpatient setting.
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