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

BMC Pediatrics

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

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 function^a	10% (81)	10% (79)
In a patient with acute renal failure^b	10% (76)	10% (74)
NON-TOXIC ANTIBIOTIC (e.g. Ampicillin)^a
In stable patient, no organ dysfunction	10% (68)	Partial agreement^c
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 agreement^d
In a patient with acute renal failure^b	10% (74)	10% (79)
In a patient with a previous opioid related adverse event^h	Partial agreement^e	Partial agreement^e
BENZODIAZEPINE (e.g. Lorazepam)
In an opioid naïve patient with normal organ function	10% (61)	10% (79)
In a patient with acute renal failure^b	10% (66)	10% (84)
In a patient with a previous opioid related adverse event^h	Partial agreement^f	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 agreement^g	1% (71)
ELECTROLYTE BOLUS (e.g. Potassium chloride)
In stable patient, no organ dysfunction	10% (66)	Partial agreementⁱ

^aAssume moderate infection, normal hepatic function and normal BMI. No drug levels yet.
^bAssume moderate infection, normal hepatic function and normal BMI. No drug levels yet. Renal dosing adjustment with Creatinine 2x normal
^cN = 20 suggested > 20% for upper threshold, and N = 12 suggested > 10%, N = 4 blank. N total = 36.
^dN = 19 suggested > 10% for upper threshold, and N = 7 suggested > 10%, N = 5 > 50%. N total = 36.
^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.
For under-dosing, N = 18 (47%) answered 21–50%, N = 6 (16%) answered 11–20%.
^fN = 6 would not give drug at all, N = 14 suggested > 10% for upper threshold, and N = 9 suggested > 10%.
^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.
^hAdverse drug event occurred with the drug dose in reference range, and resulted in a 2-day prolongation of hospital stay.
ⁱN = 12 answered > 10% (32%), N = 21 answered > 20% (57%), N = 1 answered > 51%, N = 3 blank. N total = 37.
Consensus not achieved for 2/15 principles.

ISSN: 1471-2431