Tenfold dosing errors (where a dose is off by a factor of 10, or 1 decimal point) are relatively common in pediatrics. Koren and Haslam identified ways to reduce these and other calculation-related dosing errors. The authors are from the Hospital for Sick Children and University of Toronto.

Recommendations to reduce the risk of over or underdosing a patient:

(1) Train and periodically test health care professionals in dose calculations.

(2) Identify individuals who are at high risk for making dose calculations errors.

(3) Identify drugs that are at high risk for dosing errors (based on toxicity, frequency of error or other criteria).

(4) Identify situations and locations where dose calculations errors are likely to occur (ICU, Emergency Department, weekends, other).

(5) Identify patients at risk for dose miscalculations (premature infants, others).

(6) Take steps to make sure that orders are clear and understandable (improve the legibility of handwritten orders, layout of numbers, etc).

(7) Independently double-check all dose calculations.

(8) Use computers to perform and check calculations (at ordering and in the pharmacy).

(9) Remove all hazardous drugs from the wards that are not essential.

(10) Use unit dosing whenever possible.

(11) Make sure that instructions are understood by patients and their families, especially if there may be a problem with understanding or language.

(12) Involve clinical pharmacists in oversight of drug dosing.

(13) Make sure that all dosing errors are reported for quality review, in order to identify potential sources of error.

(14) Have a process to resolve disagreements.

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