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Table 3 Proportion below and above reference range dosing that expert participants would consider is a dosing error, and proportion of consensus agreement

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

Drug Class and Patient characteristics Threshold for dosing error below reference range (% consensus) Threshold for dosing error Above reference range (% consensus)
NEPHROTOXIC ANTIBIOTIC (e.g. Gentamicin, Vancomycin)
 In a patient with normal renal functiona 10% (81) 10% (79)
 In a patient with acute renal failureb 10% (76) 10% (74)
NON-TOXIC ANTIBIOTIC (e.g. Ampicillin)a
 In stable patient, no organ dysfunction 10% (68) Partial agreementc
HEPATOTOXIC MEDICATION (e.g. Acetaminophen)
 In patient with normal hepatic function 10% (74) 10% (76)
 In a patient with acute hepatic failure 10% (76) 10% (74)
OPIOID (e.g Morphine)
 In an opioid naïve patient with normal organ function 10% (66) 10% (71)
 In a patient with an opioid tolerance 10% (63) Partial agreementd
 In a patient with acute renal failureb 10% (74) 10% (79)
 In a patient with a previous opioid related adverse eventh Partial agreemente Partial agreemente
BENZODIAZEPINE (e.g. Lorazepam)
 In an opioid naïve patient with normal organ function 10% (61) 10% (79)
 In a patient with acute renal failureb 10% (66) 10% (84)
 In a patient with a previous opioid related adverse eventh Partial agreementf 10% (60)
ANTICOAGULANT (e.g. Heparin)
 In a stable patient, no organ dysfunction 10% (71) 10% (73)
 In a patient with a previous heparin-related hemorrhage Partial agreementg 1% (71)
ELECTROLYTE BOLUS (e.g. Potassium chloride)
 In stable patient, no organ dysfunction 10% (66) Partial agreementi
  1. aAssume moderate infection, normal hepatic function and normal BMI. No drug levels yet.
  2. bAssume moderate infection, normal hepatic function and normal BMI. No drug levels yet. Renal dosing adjustment with Creatinine 2x normal
  3. cN = 20 suggested > 20% for upper threshold, and N = 12 suggested > 10%, N = 4 blank. N total = 36.
  4. dN = 19 suggested > 10% for upper threshold, and N = 7 suggested > 10%, N = 5 > 50%. N total = 36.
  5. eN = 6 would not give drug at all. For overdoing, N = 22 (58%) answered 1–10%, N = 7 (18%) answered > 10%, N = 1 answered> 20%, N = 1 blank.
  6. For under-dosing, N = 18 (47%) answered 21–50%, N = 6 (16%) answered 11–20%.
  7. fN = 6 would not give drug at all, N = 14 suggested > 10% for upper threshold, and N = 9 suggested > 10%.
  8. gN = 3 (8%) answered 1–10%, N = 21 answered > 10% (58%), N = 7 answered > 20% (19%), N = 2 answered > 50%, N = 4 blank or I don’t know. N total = 37.
  9. hAdverse drug event occurred with the drug dose in reference range, and resulted in a 2-day prolongation of hospital stay.
  10. iN = 12 answered > 10% (32%), N = 21 answered > 20% (57%), N = 1 answered > 51%, N = 3 blank. N total = 37.
  11. Consensus not achieved for 2/15 principles.