Medicines Management in Children′s Nursing

Karen Blair

• Publisher: Learning Matters
• Year: 2011
• ISBN:
  9781844457526
• Edition: 1
• Topic: Medicina
• Subtopic: Habilidades de enfermería

Children?s nurses must develop the crucial skills of correct medicines management and calculations in order to provide safe care to their patients. This book specifically supports pre-registration students in meeting the required competencies for medicines management needed to pass formal assessment and qualify as a children?s nurse. It is clearly structured around the NMC Essential Skills Clusters for medicines management, covering legal aspects, drugs calculations, administration, storage, record keeping, introductory pharmacology, patient communication and contextual issues in medication. The book is written in user-friendly language and uses patient scenarios to explain concepts and apply theory to practice.

Chapter 1
Calculating children’s medicines

NMC Standards for Pre-registration Nursing Education

This chapter will address the following competencies:

Domain 3: Nursing practice and decision-making

6. All nurses must practise safely by being aware of the correct use, limitations and hazards of common interventions, including nursing activities, treatments, the calculation and administration of medicines, and the use of medical devices and equipment. The nurse must be able to evaluate their use, report any concerns promptly through appropriate channels and modify care where necessary to maintain safety. They must contribute to the collection of local and national data and formulation of policy on risks, hazards and adverse outcomes.

6.1 Children’s nurses must have numeracy skills for medicines management, assessment, measuring, monitoring and recording which recognise the particular vulnerability of infants and young children in relation to accurate medicines calculation.

NMC Essential Skills Clusters

This chapter will address the following ESCs:

Cluster: Medicines management

33. People can trust the newly registered graduate nurse to correctly and safely undertake medicines calculations.

By entry to the register:

2. Is competent in the process of medication-related calculation in nursing field involving:

• tablets and capsules
• liquid medicines
• injections
• IV infusions, including:
  – unit dose
  – sub and multiple unit dose
  – complex calculations
  – SI unit conversion.

Chapter aims

By the end of this chapter, you should be able to:

• estimate what a reasonable dose would be;
• demonstrate a sound understanding of the metric system and SI units of mass and volume;
• calculate paediatric drug doses;
• calculate rates for intravenous fluids;
• demonstrate an awareness of professional decision making when administrating medicines.

Case study

Many years ago, as a fairly newly qualified children’s nurse on night duty, I was dealing with a seriously ill baby admitted with meningitis and was supporting a consultant paediatrician and a doctor who was relatively inexperienced in paediatrics. The consultant asked me to prepare the intravenous antibiotics, but the less experienced doctor insisted he would do this himself and did not require my help. The drugs were prepared and administered to the baby by the less experienced doctor swiftly, as the situation warranted, without checking with me or the consultant. As soon as the baby was stabilised, I started tidying up the treatment area, including the drugs used, and picked up an empty gentamicin vial and asked the doctor where it had all gone. He immediately realised his error, as he had mistakenly administered the whole vial to the baby, which was four times the recommended dose. Thankfully the baby recovered, but needed very close monitoring for drug toxicity, which could lead to kidney damage and hearing loss.

Introduction

The above case study highlights the important factors children’s nurses should be aware of when calculating and administering medicines to children. Unlike for most adult patients, children’s doses need to be calculated on an individual basis according to their age, weight or body surface area. A drug miscalculation in a child can have catastrophic effects and all care needs to be taken to avoid this. As a children’s nurse you must have an awareness of what a sensible dose would be for the children in your care, and guide other professionals and parents. You need to be confident and skilled in your ability to calculate doses in all situations.

This chapter will start by reviewing the metric system in order that you are able to understand the basic units of measurement used in the prescribing of drugs and how drug strengths are expressed, including percentages and units. You should feel comfortable about converting from one unit of measurement to another, and understand the terms of expression in medicines. As most drugs are prescribed according to a child’s weight, converting weights from imperial to metric will be covered and vice versa, including methods of estimating a child’s weight in an emergency situation. This will help you always to have in mind what is a sensible estimate of weight at different ages, so you can be confident the recorded weight on the child’s drug chart is correct.

The chapter covers the calculation of tablets and capsules, and the more commonly used liquid medicines and intravenous fluids, and how to work out if the prescribed dose or rate is correct for the child. It is essential that the children’s nurse administering the dose is capable of checking the calculation and has an awareness of what a reasonable dose would be. Throughout the chapter there will be worked examples in order to demonstrate the methods used and activities for you to practise the skills needed to gain competence.

The metric system

In order to calculate medicine dosages safely, it is essential to have a clear understanding of the units of measurements used in the prescribing and dispensing of drugs. The strength of medicines should always be expressed using the standard metric system of weights and measures. The basic units used in clinical practice derive from the Système International (SI). The SI units for weight (mass) are shown in Table 1.1 and those for volume in Table 1.2.

Note that nanograms and picograms are rarely used in clinical practice.

The terms ‘micrograms’, ‘nanograms’ and ‘picograms’ should NOT be abbreviated but always written in full. This is to prevent medication error attributable to abbreviations. Abbreviating micrograms as µg (the official abbreviation for microgram in the SI system) can be mistaken for mg and lead to a one thousandfold dosage error.

Table 1.1: The SI units for weight (mass)

Table 1.2: The SI units for volume

Note that the term ‘millilitre’ (ml or mL) is used in medicine and pharmacy rather than cubic centimetre abbreviated as ‘cc’, as this can be mistaken for ‘u’ (units) when poorly written.

The term ‘litre’ is generally not abbreviated to avoid error. It is safer to express volume in millilitres in order to avoid the unnecessary use of...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Foreword
• About the author
• Introduction
• 1 Calculating children’s medicines
• 2 Legal and ethical issues in children’s medicines management
• 3 Holistic care and treatment options in children’s nursing
• 4 Knowledge of children’s medicines and their actions
• 5 Storing, ordering and receiving medicines in children’s nursing
• 6 Medicines administration in children’s nursing
• 7 Working in partnership with parents, carers and children in medicines management
• 8 Keeping up to date with evidence-based practice
• Glossary
• References
• Index