Safe prescribing, administration and monitoring — formative SAQs

SAQ 1 (10 marks)

A 6-year-old, 20 kg, on the ward for a skin infection is prescribed flucloxacillin and gentamicin. The team uses extended-interval gentamicin dosing. ^[9]

1. Outline the medication-use process and state which stage generates the most errors in children, with the evidence. (3) ^[1]
2. Describe the rights of medication administration and explain what makes a double-check effective for a high-alert medicine. (3) ^[6]
3. State how you would monitor the gentamicin, including the sample timing and the target. (4) ^[9]

Model answer

The medication-use process runs through prescribing, transcribing, dispensing, administering, and monitoring. Prescribing generates the most errors in children — Kaushal's cohort found medication errors in roughly 6 in 100 paediatric inpatient orders, highest in PICU and NICU, with the prescribing stage the largest contributor — because every paediatric dose is weight-based and therefore an arithmetic act. ^{[1] [2]}

The rights of administration are right patient (two identifiers), right drug, right dose (independently re-calculated by weight), right route, right time and frequency, and right reason and documentation, with the modern additions of right formulation, right rate for infusions, and right response by monitoring the effect. A double-check is effective only when it is independent: the second person re-calculates the dose and pump settings from the weight and the reference, then compares — not merely agreeing with the first number. Reserve independent checks for high-alert medicines such as insulin, opioids, concentrated electrolytes, anticoagulants, and chemotherapy, where they have the highest yield. ^[6]

For extended-interval gentamicin, take a trough level immediately before the second or third dose; the target is a trough less than 1 mg per litre, which avoids accumulation and the nephro- and ototoxicity that follow it. Review renal function before and during therapy, extend the interval or hold the dose if the trough is above target, and tie each level to a documented action so a result is never merely filed. ^[9]