This
research provides some insight on the impact of a standardized
weight-based dosing procedure. We identified that 3% of all
pediatric prescriptions prompted a pharmacist intervention
because of the weight-based dosing procedure. Interestingly,
50% of pharmacist-recommended interventions resulted in a change to the original prescription. Interventions were rejected
for a variety of reasons, such as inappropriate dose for a patient's
illness or condition per hospital protocol, off-label dosing,
or clarification of an illegible prescription. Nonetheless, pharmacist
interventions could reduce pediatric medication errors
that are prevalent in outpatient pharmacies.
Opportunities to study the impact of pharmacist intervention
on antiretroviral agents, chemotherapeutic agents,
hypoglycemic agents, immunosuppressant agents, insulin,
opioids, and liquids that require measurement in the pediatric
population are needed. These medication classes have the
greatest potential for causing harm in this population. In this
study, opioids and immunosuppressant agents were the most
prevalent high-alert medication classes observed in this study.
Of the prescriptions requiring intervention, the majority were
for children weighing less than 20 kg (54%) and children 5 years
and younger (53%). In addition, the majority of prescribing errors
were for overdose (59%). Because prescriptions that were not
sent to the problem queue were not analyzed, we are unable to
draw conclusions on relationships between age, weight, prescription
origin, and prescriber origin of pediatric prescriptions;
however, further study is warranted in this area.
This weight-based dosing procedure can be applied to
other outpatient pharmacies. The most significant challenge
will be obtaining the patient's weight from either the prescriber
or patient's parent or guardian before dispensing.
Currently, many providers do not routinely print patient
weight on the prescription. By instituting a standardized
weight-based dosing procedure across outpatient pharmacies,
this practice can be changed. Initially, there might likely be
increased calls to prescribers but over time, prescribing practices
will adapt. Patient weight consideration will also build
trust between pharmacists and patients as it helps to further
individualize care. Pharmacies can also carry scales.
The pharmacist will also need access to appropriate drug
information to screen the prescription properly. Although the
weight-based dosing procedure in the study uses two pharmacists
to ensure proper calculations, the procedure could be
conducted by a single pharmacist or a pharmacist-intern
combination. The time needed to complete the weight-based
dosing procedure is significant. On average at the study location,
it takes 2- to 2.5 times longer to complete this dosing
procedure compared to an adult prescription. There is a
glaring need for an efficient and easy-to-use electronic application
program that will make standardizing a weight-based dosing procedure feasible in outpatient pharmacies; this, too,
can help to build pharmacist confidence in properly screening
pediatric prescriptions. At a minimum, it should be used for
high-alert medications in the pediatric population. Ideally, it
should not significantly increase time to fill and should prompt
prescriber contact when truly warranted.