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Paeds Vivasclinical-pharmacology-and-therapeutics

Paeds Vivas · clinical-pharmacology-and-therapeutics

Safe prescribing, administration and monitoring — branching viva

Viva on safe prescribing, administration and monitoring of medicines in children, centred on a medication error and a therapeutic level.

branching clinical structured oral3 min readVerification in progress

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A 3-year-old, 14 kg, in PICU with a Staphylococcus aureus bacteraemia is on vancomycin and gentamicin. A routine pre-dose gentamicin level returns above target, and the team also asks how your unit prevents tenfold errors in high-alert medicines.

Opening (candidate)

I would treat this as two linked problems: a supratherapeutic gentamicin level that needs immediate action, and a system question about how we prevent high-alert-medicine errors. For the level, I would stop or extend the gentamicin, assess renal function and the child for toxicity, and review the prescribing and monitoring chain. For prevention, I would describe the layered system — decision-supported prescribing, unit-based pharmacists, standard concentrations, independent checks, reconciliation, and monitoring with level-to-action protocols. [9] [6]

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References5ShowHide
  1. [1]Kaushal R, Bates DW, Landrigan C, McKenna KJ, Clapp MD, Federico F Medication errors and adverse drug events in pediatric inpatients. JAMA, 2001.PMID 11311101
  2. [2]Fortescue EB, Kaushal R, Landrigan CP, McKenna KJ, Clapp MD, Federico F Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics, 2003.PMID 12671103
  3. [6]Doherty C, Mc Donnell C Tenfold medication errors: 5 years' experience at a university-affiliated pediatric hospital. Pediatrics, 2012.PMID 22473367
  4. [9]Lopez SA, Mulla H, Durward A, Tibby SM Extended-interval gentamicin: population pharmacokinetics in pediatric critical illness. Pediatric critical care medicine, 2010.PMID 19770786
  5. [11]Rybak MJ, Le J, Lodise T, Levine D, Bradley J, Liu C Executive Summary: Therapeutic Monitoring of Vancomycin for Serious Methicillin-Resistant Staphylococcus aureus Infections: A Revised Consensus Guideline and Review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists. Journal of the Pediatric Infectious Diseases Society, 2020.PMID 32659787
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