Pediatric medication doses are weight-based, unlike the standard dosing units used for adult patients, and the recommended dosages are given in relation to weight in kilograms. But in many hospitals, children are weighed in pounds. The measurement must then be converted to kilograms, often leading to confusion, inaccurate calculations and medication errors.

In an effort to reduce medication dosing errors, the Emergency Nurses Association (ENA) has developed and released a position statement in support of weighing pediatric patients in kilograms only.

ENA Position

It is the position of the ENA that:

1. Pediatric weights only be measured and documented in kilograms.

2. Scales used to weigh pediatric patients only be configured to record weights in kilograms.

3. Pediatric weights are recorded in a prominent place on the medical record.

4. Electronic medical records are standardized to allow only kilograms for pediatric weight entries.

5. The pediatric patient's actual weight is considered part of the mandatory nursing assessment unless they require resuscitation or emergent stabilization.

6. For the pediatric patient who requires resuscitation or emergent stabilization, a standard method of estimating weight in kilograms is used (e.g., length-based system).

7. The pediatric patient's weight in kilograms is included in any inter or intradisciplinary patient handoff report.

Recently, the American College of Emergency Physicians, the American Academy of Pediatrics, the Institute for Safe Medication Practices, the American Academy of Emergency Medicine and the Society of Pediatric Nurses have all endorsed ENA's position statement.

Deena Brecher, MSN, RN, APRN, ACNS-BC, CEN, CPEN, clinical nurse specialist in the emergency department at the Nemours/Alfred I. duPont Hospital for Children (N/AIDHC) in Wilmington, DE, and president-elect of the ENA, explained why the measure is so necessary.

"The ENA has long been interested in safety efforts related to emergency pediatric patient care. Over the past several years, there has been an increasing body of knowledge related to the identification and mitigation of pediatric medication errors during emergency situations. Because pediatric patients require dose calculation based on weight, only one weight measurement should be used, thus our interest in this safety topic and support of the use of the metric unit as the standard since that is the way we calculate the medications," she said.

While the position statement was issued at the end of last year, N/AIDHC has been weighing all ED patients in kilograms for at least as long as Brecher has been there since 2004.

The Right Equipment

In N/AIDHC's ED, scales only display kilograms; they have actually disabled the pounds display. "We are working on a housewide initiative to ensure the same safety practices are in place regardless of where the weight is measured," she added. "Many electronic scales can display just kilograms. Nurses should work with their clinical engineering departments to make the changes. This is one of the most misunderstood aspects of this issue [that scales would have to be thrown out and new ones purchased]. In fact, the majority of the scales can be after-market locked."

While it seems like the practice of weighing children in kilograms would be fairly simple to implement at children's hospitals, there could be challenges at other facilities that don't serve children exclusively.

To that, Brecher said hospitals should be weighing all patients in kilograms for the purposes of medication safety. "When you think about it, most medications that are dosed by weight are dosed in mg/kg, regardless of the age of the patient," she explained. In fact, the ENA subsequently published a second position statement supporting weights in kilograms for all ages.

The expense of updating documentation to accept kilogram entries and replacing scales that do not display kilograms can also be restrictive. "Staying focused on doing what's right for the safety of our patients will help to overcome these challenges," Brecher said.

While no statistics have yet been released to show a decrease in medication errors, "Anecdotally, we know that the fewer times we do math conversions in our heads, the fewer times we make mistakes," Brecher said. "When we do have an error, we work diligently to assess the process to identify areas to improve. We continue to work to assess our processes and decrease the number of times data entry errors occur." 

Elizabeth Rosto Sitko is on staff at ADVANCE. Contact: ESitko@advanceweb.com