Pediatric Weight is Crucial to Perfecting the Dose

Cat is a 1-year-old who experiences frequent ear infections typically treated with antibiotics using her body weight for dose calculation. However, recent data show that 60% of pediatric antibiotic prescriptions are dosed incorrectly.¹ When made aware of this data, Cat’s primary care physician acknowledged that it sounds accurate, but then underdosed Cat’s antibiotics every time she was treated.

According to the CDC, 18% of children 0 to 11 years of age and 27% of adolescents 12 to 19 years of age have received a prescription drug in the past 30 days.² In these patients, body weight is a crucial factor in determining the appropriate dosage of most prescription medications. Even small dosing errors can have serious consequences in children, ranging from ineffective treatment to harmful adverse effects, some of which can lead to escalations in care, including hospital admission.

Why Do Dosing Errors in Children’s Medication Occur, How Widespread Is It, and What Can Be Done to Prevent Them?

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Dosing errors occur because providers miscalculate the appropriate dose due to mathematical errors, incorrect medication concentrations, wrong measuring units or tools, and miscommunication with caregivers. Compounding the problem, pharmacies do not receive, collect, or document patients’ weight when assessing the appropriateness of a prescription.

Evidence indicates that up to 25% of all prescriptions for children could be dosed inappropriately, making it the most common type of medication administration error.^2,3 Assessment of Weights in Pediatrics is a community pharmacy quality measure in Seguridad’s Choose My Pharmacy and is one of 18 quality measures used to evaluate the safety and quality of community pharmacies to support value-based contracting, appropriate metrics/measures of pharmacies, and quality improvement. Assessment of Weights in Pediatrics is a straightforward measure—what percent of patients 17 years and younger have a weight documented at the pharmacy. And the results are alarming. Many pharmacy management systems are unable to document weight and as the adage goes, if the weight wasn’t recorded, it wasn’t used to assess the prescription.

Several professional organizations have advocated for the inclusion of patient weight on prescriptions for pediatric patients. In 2016, the American Academy of Pediatrics affirmed the need for electronic prescriptions to include metric weight in prescription generation and transmission with certain exceptions (e.g., topical, otic, and ophthalmic medications).⁴ A prescription standard was created that recommended, but did not require, that electronic prescriptions for children include the patient’s weight. The Pediatric Pharmacy Association (PPA) has advocated for a federal mandate that all electronic prescriptions for children and adults include the patient’s metric weight to facilitate a pharmacist’s dose check and improve patient safety.⁵ Lastly, the Institute for Safe Medication Practices (ISMP) issued a statement about mandating patient weights on medication prescriptions. ISMP’s statement urges regulatory agencies such as boards of pharmacy to require the use of patient weight on electronic prescriptions. Clearly, the necessity of including patient weight on pediatric prescriptions is a matter of national attention and urgent need.

A Call to Action for All Pharmacy Teams

• Assess the weight of every child: Pharmacists and pharmacy technicians are clinicians and able to collect, assess, and develop care plans based on clinical data. When a community pharmacy does point-of-care testing for strep throat, the treatments are weight-based.⁶ Regardless of the availability of weight via e-script or prescriber documentation, pharmacies can and should collect and document a patient’s weight.
• Call the prescriber: The minimum standard for every pharmacy is to ensure the 5 rights, including the right dose. If any aspect of the prescription is unclear, pharmacy teams should contact the prescriber to resolve issues.
• Interoperability of health care: As noted above, AAP, PPA, ISMP, and many other organizations have advocated for the inclusion of patient weight on prescriptions. The National Council of Prescription Drug Programs (NCPDP) has weight as an interoperable data element. The Office of the National Coordinator’s Pharmacy Interoperability and Emergency Therapeutics Task Force released recent recommendations including pediatric weight as an example of an idea pharmacy quality measure for interoperability and improvement of patient safety.⁷

Perfecting the dose improves safety, improves quality, and drives value. For example, a self-insured employer with 1000 employees will spend approximately $35,000 per year treating otitis media. This assumes every prescription is dosed correctly. But 60% of prescriptions are dosed incorrectly, which increases the total cost of care to $56,000. Ensuring the right dose saves $21,000 annually just for one diagnosis.^1,8-11

Although the focus of this article has been on the value of perfecting the pediatric antibiotic dose, knowing a patient’s weight is much more than an antibiotic dose. Epinephrine is weight-based for pediatric patients. Are pharmacies prepared to treat severe immunization adverse reactions with the right dose? And its value is much more than otitis media optimization. Another of Seguridad’s quality measures is Longitudinal Antiobesity Management, the routine monitoring and assessment of weight for patients on antiobesity therapy, for adults and children alike.

Pharmacists are integral members of health care delivery, and assessing the appropriateness of prescriptions is one of their primary functions and statutory obligations. To ensure safe, optimized care pharmacists must validate that the right patient gets the right dose, at the right time, by the right route, with the right medication, for the right reason. Safer pharmacies perfect the dose by incorporating weight in patient assessment.

References

1. Holder K, Oprinovich S, Guthrie K. Evaluating pediatric weight-based antibiotic dosing in a community pharmacy. J Am Pharm Assoc (2003). 2023 Jul-Aug;63(4S):S52-S56. doi: 10.1016/j.japh.2022.12.011. Epub 2022 Dec 11. PMID: 36588061.

2. Prescription Drug Use in the United States, 2015 – 2016. Center for Disease Control and Prevention. https://www.cdc.gov/nchs/products/databriefs/db334.htm#:~:text=Prescription%20drug%20use%20increased%20with%20age%2C%20overall%20and%20among%20males,in%20the%20past%2030%20days

3. Parand A, Garfield S, Vincent C, Franklin BD. Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review. PLoS One. 2016 Dec 1;11(12):e0167204. doi: 10.1371/journal.pone.0167204

4. Standards group approves AAP proposal to include weight on e-prescriptions. https://publications.aap.org/aapnews/news/13592/Standards-group-approves-AAP-proposal-to-include?autologincheck=redirected

5. Lubsch L, Kimler K, Passerrello N, Parman M, Dunn A, Meyers R. Patient Weight Should Be Included on All Medication Prescriptions. J Pediatr Pharmacol Ther. 2023;28(4):380-381. doi: 10.5863/1551-6776-28.4.380. Epub 2023 Aug 9. PMID: 37795278; PMCID: PMC10547047.

6. Test & Treat Toolkit. Iowa Pharmacy Association. Accessed June 3, 2024. https://www.iarx.org/test-treat

7. Pharmacy Interoperability and Emerging Therapeutics Task Force 2023. Office of the National Coordinator for Health Information Technology. https://www.healthit.gov/hitac/committees/pharmacy-interoperability-and-emerging-therapeutics-task-force-2023

8. Working Parents & The American Workforce. G&A Partners. Updated September 14, 2017. Accessed June 3, 2024. https://www.gnapartners.com/resources/infographics/working-parents-the-american-workforce

9. Average number of own children under 18 in families with children in the United States from 1960 to 2023. Statista. Accessed June 3, 2024. https://www.statista.com/statistics/718084/average-number-of-own-children-per-family/

10. Usonis V, Jackowska T, Petraitiene S, et al. Incidence of acute otitis media in children below 6 years of age seen in medical practices in five East European countries. BMC Pediatrics. 2016;16(108). doi:10.1186/s12887-016-0638-2

11. Watanabe JH, McInnis T, Hirsch JD. Cost of Prescription Drug-Related Morbidity and Mortality. Ann Pharmacother. 2018 Sep;52(9):829-837. doi: 10.1177/1060028018765159. Epub 2018 Mar 26. PMID: 29577766.