The inability to calculate therapeutic dosages for children accounts for the majority of pediatric drug errors, according to Ronda G. Hughes, PhD, MHS, RN, and Elizabeth A. Edgerton, MD, MPH, of the Agency for Healthcare Research and Quality. But there are practical ways for nurses—who often have primary responsibility for ensuring patient safety in the hospital and are usually the providers who administer the medications—to reduce the likelihood of a mistake.

Most pediatric medication errors occur in the prescribing or ordering phase—usually dosing errors—followed by mistakes in administration of the drug, note Drs. Hughes and Edgerton in a recent article in the American Journal of Nursing. Because most medications are developed in concentrations for adults and do not include pediatric dosage guidelines, the correct dosage must be calculated according to the child's weight. The dosage must also take into account the child's prematurity status and particular disease or health.

Because of their immature physiology, children are more likely than adults to be harmed by medication error. Pediatric nurses are in a position both to catch mistakes before the drug is given and to avoid mistakes in administering the medication. How, specifically? Recommendations by Drs. Hughes and Edgerton include the following:

• Report medication errors—to understand how to avoid future mistakes
• Know the medication before administering it. Double-check drugs prescribed off label and be cautious when administering "high-alert" medications such as corticosteroids, antibiotics, and insulin
• Confirm patient information before administering medications. Check, for example, that the patient's most recent weight was used in calculating the dose.
• Double-check orders and collaborate with other clinicians to verify information, especially for illegible or verbal orders and discrepancies between standard drug protocols and the patient's order
• Minimize distractions during administration
• Communicate with parents and families and involve them in patient care, and educate them about medication administration when the child is discharged

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