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Table 2 Principles of dosing error, agreement statement, and proportion of consensus agreementa for each statement

From: A modified Delphi to define drug dosing errors in pediatric critical care

 

Proportion of agreement (%)

Round agreement achieved

YES, DEFINITELY constitutes a dosing error

 Dosing a drug above reference range, but the drug dose was intercepted (near-miss) and did not reach patient

76 Round 1

 Dosing a drug below the minimum recommended dose, when the drug is possibly life-saving

73 Round 2

YES, PROBABLY constitutes a dosing error

 Dosing a drug in a dose that is predicted to give serum levels below desired therapeutic range (e.g. 50% below lower limit target)

62 Round 2

 Dosing a drug by weight, without accounting for a significant drug interaction

68 Round 3

 Dosing a drug in a dose that is likely to give serum levels above desired therapeutic range (e.g. 50% above upper limit target)

60 Round 2

MAY or MAY NOT be a dosing Error

 Dosing a drug by weight, without adjusting for age

76 Round 2

 Dosing a drug by weight, without accounting for body surface area

73 Round 1

 Dosing a drug dose above the maximum dose recommended in the hospital formulary, guideline or reference sources

66 Round 2

 Dosing a drug above the maximum recommended dose, in a patient who is in end-of life care

71 Round 2

 Dosing a drug above the maximum recommended dose in a patient who is on ECMOb

82 Round 2

 Dosing a drug above the maximum recommended dose, when the drug is possibly life-saving (e.g. antibiotics in sepsis)

60 Round 2

 Dosing a drug by weight, without adjusting for renal insufficiency (Creatinine 50% higher than baseline)

69 Round 3

NO, UNLIKELY to constitute a dosing error

 Dosing a drug dose that cannot easily be administered using dosage forms available

66 Round 2

NO, DEFINITELY NOT a dosing error

 None

 

Dosing a drug at a dose where the patient has had a previous severe adverse event

Partial agreementc

Dosing a drug for which the use is off-label in children (i.e. prescribed for a condition that it is not officially approved for)

Partial agreementd

  1. N for Round 1 is 42, N for Round 37, N for Round 3 is 36
  2. aConsensus agreement established a priori was > = 70% for Round 1, and > =60% for Rounds 2 and 3.
  3. bECMO: Extra-Corporeal Membrane Oxygenation.
  4. cN = 21 (58%) responded “Yes, definitely dosing error”, N = 1 “Yes, probable dosing error” and N = 14 (39%) “May or May not be error”. N total = 36 participants.
  5. dN = 20 (55%) “No Definitely not a dosing error”, N = 12 (33%) “No, probably not a dosing error”, N = 3 (8%) “May or may not be a dosing error”, N = 1 (3%) “I don’t know”. N total = 36 participants.