Prescribing in paediatrics is generally calculated using weight, however once an individual reaches adulthood medication is prescribed based on the standard adult dose. This study looks at a group of young adults managed within a children’s hospice, who as a result of life-limiting conditions, may be of lower or higher weights than the average adult.
Aims Identify whether patients aged 16 and over are receiving appropriate doses when compared to the recommended dose for their weight. Establish any trends in conditions vulnerable to low, or high, weights. Make recommendations to the hospice on current prescribing practice.
The study was conducted at a local children’s hospice, which provides services for patients up to 30 years old. 101 individuals were suitable for the study, aged between 16 and 29 years. Patient notes were looked at retrospectively and prospectively, and their most current weights recorded. Individual conditions were noted to establish any trends related to low or high weights.
Results illustrated a large range of weights amongst people of a similar age, which current prescribing practice does not take into account. 58.4% of patients fell below the threshold set by the hospice for adult weight, this being 50 kg, shown in Figure 1.
In contrast there were patients at the higher end of the weight range, with 4.9% of patients weighing over 90 kg. These results emphasise extremes of weights amongst the young adults, posing the question:
Are patients receiving correct doses of medication in relation to their weight and is this providing them with a therapeutic dose?
Unlike paediatric prescribing, based on patient weight, adults are administered standard doses of medication irrespective of their weight. This could result in potentially dangerous doses of medication being administered, especially for underweight patients. For example a large dose of opioids or benzodiazepines could have devastating consequences. Similarly, very large patients may not receive therapeutic doses of medication. Weight-based prescribing should be used in adults as well as paediatrics, to ensure individualised patient care and more importantly, patient safety