1. Medication Review

2. Pediatric Dosing
The largest difference between pediatric dosing and adult dosing is weight based calculations for peds.
Weight dosing is done based on KILOGRAMS (not pounds).
Example: 45 mg/kg of Amoxicillin BID
Adult: 500mg Amoxicillin given daily
Kg= pounds / 2.2
*Kg is a smaller number than pounds
Home care differs from hospital care in that parents do occasionally give the medications. No electronic charting/ med scanning. Pharmacy is not in-house.
Still have to ONLY work off of orders like in hospital:
Nurses CAN NOT give OTC meds in the home without an order
Can not stop parents from giving these meds if they want to : but needs to be documented

3. What is the nurse responsible for?
Safety of ordered dose:
Is the dose within the SAFE parameters
Ie. Anti-epileptics are dosed based on weight/ severity/ type of seizure. You are not responsible to say “this is the best size dose for my patient”, rather : with my patient’s weight he could be prescribed between mg daily. Is this dose between those numbers?
Is this patient on other medications (may be prescribed by different doctors) that will interact with this medication?
SAME side effects
SAME place of metabolism
SAME ingredients: ie. Tylenol and Percocet
Timing:
Will this interfere with sleep/ feeding schedule/ other medications that have to be given now?
PRN Meds:
Is it appropriate to give this medication? **Look at indication for reason to give: ie. Tylenol can be ordered for pain OR fever OR both. Cannot give for pain if only ordered for fever, etc.

4. 6 Rights of Medication Administration
RIGHT medication
RIGHT patient
RIGHT time
RIGHT route
RIGHT dose
RIGHT documentation
Do I really need to go through this since I only have one patient and I am working in their home??
YES.

5. Common meds you will give
Tylenol
safe dosing is mg/kg/ dose every 4 hours **Do NOT exceed 4 doses in 24 hours!
Ibuprofen
10 mg/kg/ dose every 6-8 hours
Pain Medications
Antispasmotics, anti-epileptics
Mostly given PO/ G-Tube routes
G-tube / “GB” = G button- meds given through this route go directly into stomach.. So they are the same concentrations and formulas as oral meds)

6. Abbreviations / Conversions
Some common Abbreviations
UNACCEPTED Abbreviations
Abbreviation: Confused between:
DC or D/C “discontinue” or “discharge”
HS “half-strength” or “at bedtime”
QD “every day” or “right eye”
QOD “every other day” or “daily
MSO4 “magnesium sulfate” or “morphine sulfate”
U or IU “unit” or “zero” or “0”
IV “intravenous” or “international units”
SQ or SC “subcutaneous” or “5Q” (“5 every”)?
use Subq, subcut.
TIW “twice a week” or “three times a week”
cc “cubic centimeter” or “milliliter”?
Ug or g “microgram” or “Ugh”?
OD “once daily” or “right eye”?
Liters= L Mililiters= mL Kilgram=Kg Miligram= mg Microgram= mcg Ounces= oz Pounds= lbs PO By Mouth PR Per Rectum GT Per Gastrostomy tube PRN As needed OTC Over the counter BID 2 times daily TID 3 Times Daily QID 4 times daily q1h Every 1 hour (can substitute any number) AC before meals P.M afternoon/ evening A.M morning (before noon) A.U both ears GTT drops Supp suppository QHS* hour of sleep (at bedtime) * Means not a recommended abbreviation, but you still may see it
*LEAD with zeros, do not follow or “trail” with zeros.
ie.: 0.02= correct =WRONG
*Rounding
liquids= round to nearest tenth of milliliter

7. Medication Admin process
Conversions
Weight
lb = kg × 2.2
kg = lb ÷ 2.2
Volume
mL = L × 1,000
L = mL ÷ 1,000
mg = g × 1,000
g = mg ÷ 1,000
mcg = mg × 1,000
mg = mcg ÷ 1,000
1ml = 1 cc
1 ounce = 30 ml
1 tablespoon (T or tbsp) = 15 ml
1 teaspoon (t or tsp) = 5 ml
Grains (gr.) 15 = 1 Gram (g) or 1000 milligrams (mg)
1 Grain (gr.) = 60 Milligrams (mg)

8. Example
A 12 kg child is ordered 10 mg/kg of Tylenol PRN pain q4hours. Tylenol is available in chewable 80 mg tabs, or 160 mg /5 ml . His pain is currently a 7-10 on the FLACC scale.
Route= Orally (PO)
Time= PRN Pain- The child is in pain and has NOT exceeded the 4 dose/day limit. So appropriate to give NOW
Dose= how much of the medication will be given
Example: 10mg x 12 kg = 120 mg kg
Concentration= how much MEDICATION is in the solution/ pill.
Example: 160mg/ 5 ml
80 mg/ 1 tab
Conversion= based on the concentration and dose
Dose (120 mg ) x Concentration ( 5 mL ) = 3.75 mL
160 mg

9. Conversion Example Dimensional analysis:
A 12 kg child is ordered 10 mg/kg of Tylenol PRN pain q4hours. Tylenol is available in chewable 80 mg tabs, or 160 mg /5 ml . His pain is currently a 7-10 on the FLACC scale.
Dimensional analysis:
Desired units x conversion formula (ie. Concentration) x Original Factors to convert
DOSE: mg= kg x 10mg = mg
1 kg
ml= mg x ml = ml mg

10. Good Resources: Lexicomp Dosing book
Lexicomp phone app- 75$ but has pediatric specific reference!
Epocrates – FREE app for phone
Online (make sure your sources are reliable)
Handout from pharmacy for specific meds