Drug formulations that require less than 0.1 mL of stock solution to prepare doses for infants and children |
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| Authors: | Navjeet Uppal Baseer Yasseen Winnie Seto Christopher S. Parshuram |
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| Affiliation: | From the Critical Care Program (Uppal, Yasseen, Parshuram), the Department of Pharmacy (Seto), the Child Health and Evaluation Sciences Program of the Research Institute (Seto, Parshuram) and the Center for Safety Research (Uppal, Yasseen, Seto), The Hospital for Sick Children, Toronto, Ont.; and the Patient Safety Centre, Faculty of Medicine (Parshuram), University of Toronto, Toronto, Ont |
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| Abstract: | Intravenous doses of medications require formulations that permit accurate preparation and administration. Current equipment does not permit accurate measurement of volumes less than 0.1 mL. In a study of four hypothetical standard pediatric patients, we found that 28 common medications required less than 0.1 mL of available formulation to prepare the dose. In a clinical study of actual use in a pediatric intensive care unit (ICU), 5245 (7.4%) of 71 218 intravenous doses required preparation from less than 0.1 mL of stock solution. For 28.5% of the 1531 ICU admissions, at least one dose was prepared from a volume of less than 0.1 mL. Our findings identify a substantial source of dosing error. Correction will require revision of preparation methods, regulatory requirements and manufacturing practices.Preparation of parenteral doses of medications from small volumes using commercially available syringes is imprecise and may result in serious dosing errors.1–3 Previously, we showed that 60% of 116 doses prepared from 0.06 mL of stock solution had a dosing error of more than 10%, and 27% had a two-fold dosing error.2 We hypothesized that small volumes of commercially available formulations are often required to prepare intravenous doses for infants and children. |
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