Dose calculation medication errors

An order was written for 30 mg Cyclosporine (immunosuppressant) oral solution to be administered to a pediatric patient. However, for several days, the nurse administered 300 mg believing that the syringe was calibrated in mg not mL. The oral solution is available as 100 mg/mL. As the pharmacist reviewed the error, he noted that the syringes accompanying the medication were never designed for pediatrics. It is not possible to calculate any dose less than 50 mg. It is imderstandable how the nurse assumed that the 3 mark was for 30 mg since it is positioned between 2,5 and 3,5 (which are European style for the decimals 2.5 and 3.5). To harmonize products in the global market, the manufacturer chose to follow European convention for expressing numbers which uses commas and decimals in the reverse manner as in the United States. 

The pediatric medication-use process is complex and error-prone owing to multiple steps required in calculating, verifying, preparing, and administering doses. 

The dose on the medication order must be within recommended guidelines. The healthcare provider should have a general idea of the dose before performing any dmg calculations. If the calculated dose varies too much from this estimated dose, check with a pharmacist or another appropriate healthcare provider. Some dmg calculations should always be checked by two individuals if the calculation is complicated or the dmg has the potential to be harmful if the dose is too large or too small. Medications that are wrapped and labeled or pre-filled for the exact dose are preferred and can reduce errors. 

What are the quantitative aspects of risk in low-level radiation exposures The data are at best uncertain (see Table 13.3), but estimates have been calculated from such human experience as medical x-ray (diagnostic and therapeutic), radiation accidents and inadvertant exposures, data from nuclear tests and from the Japanese experience, and similar sources. Because of the presence of many variables, these data are subject to a wide margin of error. Regulatory agencies have derived limits of exposure based upon a linear dose-response relationship and have assumed that no dose threshold exists. This approach is the most conservative, and will limit the risk to produce the smallest individual risk in all cases (346). 

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