Arch Dis Child 1998;79:56-58 ( July )

Errors by paediatric residents in calculating drug doses

C Rowe, T Koren, G Koren

Division of Clinical Pharmacology/ Toxicology, Department of Paediatrics and Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada

Correspondence to: Dr G Koren.

Accepted 3 February 1998

BACKGROUNDErrors in calculating drug doses in infants and small children can cause morbidity and mortality, especially with agents exhibiting a narrow therapeutic window. A previous study from this institution has detected potential life threatening errors in calculations performed by trainees while writing prescriptions.
OBJECTIVESTo verify whether the true incidence of trainees' errors in prescribing can be explained by impaired calculation skills in written tests.
SETTINGA tertiary paediatric hospital; educational rounds for core paediatric residents.
METHODSTwo anonymous written tests, which included calculations of doses similar to those performed at the paediatric bedside; one was conducted in 1993 and one in 1995.
RESULTSThirty four paediatric residents participated in 1993 and 30 in 1995. A substantial number of trainees in both years committed at least one error. In general, there was no correlation between the length of training (0 to 4 years) and likelihood of making a mistake. Three trainees in 1993 and four in 1995 committed 10-fold errors. These seven residents committed significantly more errors than the rest of the group in each of the tests separately. All seven were in their first two years of training, and six were in their first year of residency.
CONCLUSIONSA substantial proportion of paediatric trainees make mistakes while calculating drug doses under optimal test conditions. Some trainees commit 10-fold errors, which may be life threatening. The results of these anonymous tests suggest that testing of calculation skills should be mandatory, and appropriate remedial steps should follow to prevent paediatric patients receiving wrong drug dosages.

Keywords: prescribing errors; residents; toxicity

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© 1998 by Archives of Disease in Childhood
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