Safe Medication Dosing

Most EMS providers have witnessed or been involved with a medication error attributable to poor system design and lack of safety behaviors. Read this article to learn more about how to prevent errors.

This clinical report is a revision of “Preparing for Pediatric Emergencies: Drugs to Consider.” It updates the list, indications, and dosages of medications used to treat pediatric emergencies in the prehospital, pediatric clinic, and emergency department settings. Although it is not an all-inclusive list of medications that may be used in all emergencies, this resource will be helpful when treating a vast majority of pediatric medical emergencies. Dosage recommendations are consistent with current emergency references such as the Advanced Pediatric Life Support and Pediatric Advanced Life Support textbooks and American Heart Association resuscitation guidelines.

Caleb E. Ward, Michael Taylor, Clare Keeney, Emily Dorosz, Cynthia Wright-Johnson, Jennifer Anders & Kathleen Brown (2022) The Impact of Documenting Patient Weight in Kilograms on Pediatric Medication Dosing Errors in Emergency Medical Services, Prehospital Emergency Care.

Objectives: MillUp to 40% of children who receive a medication from Emergency Medical Services (EMS) are subject to a dosing error. One of the reasons for this is difficulties adjusting dosages for weight. Converting weights from pounds to kilograms complicates this further. This is the rationale for the National EMS Quality Alliance measure Pediatrics-03b, which measures the proportion of children with a weight documented in kilograms. However, there is little evidence that this practice is associated with lower rates of dosing errors. Therefore, our objective was to determine whether EMS documentation of weight in kilograms was associated with a lower rate of pediatric medication dosing errors.

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This spreadsheet is designed to provide general information about dosage, equipment and vital signs for pediatric emergency care purposes. It is customizable in order to allow for users to enter the appropriate dosing regimens and medication concentrations appropriate to their EMS service or healthcare institution. Instructions are provided regarding customization of this Excel spreadsheet. Reasonable efforts have been made to prevent corruption of this document during the customization process, however, users should verify the accuracy of calculations before deploying this reference tool within their organization.

(from Colorado EMSC - click "Open Resource" to download spreadsheet)

PPT Presentation (Dr. Kathleen Adelgais)

January 2020

Medication Dosing Safety for Pediatric Patients: Recognizing Gaps, Safety Threats, and Best Practices in the Emergency Medical Services Setting. A Position Statement and Resource Document from NAEMSP. (2020)

Background: Millions of patients receive medications in the Emergency Medical Services (EMS) setting annually, and dosing safety is critically important. The need for weight-based dosing in pediatric patients and variability in medication concentrations available in the EMS setting may require EMS providers to perform complex calculations to derive the appropriate dose to deliver. These factors can significantly increase the risk for harm when dose calculations are inaccurate or incorrect.

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Michigan specific volumetric dosing guide based on state formulary and specific concentrations

(version 3.0, 2019 revision)

Objective: To identify Emergency Medical Services (EMS) provider perceptions of factors that may affect the occurrence, identification, reporting, and reduction of near misses and adverse events in the pediatric EMS patient.

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