Most paediatric analgesia failures on a ward are dosing failures, not drug choice failures. The prescription says 'paracetamol as required', the weight on the chart is from admission three days ago, and the child receives three doses a day instead of four because nobody was asked.
So write it fully. Weight-based dose in milligrams, not in millilitres of an unspecified syrup concentration - syrups come in more than one strength and the substitution error is common. Regular rather than as-required for the first 48 hours after a painful procedure, because as-required means the child has to complain and children under-report. A maximum daily dose written out, particularly where a combination preparation may also be given at home. And a review or stop date, so the drug does not follow the child out of the door indefinitely.
The same discipline applies to the parents' copy. Send them home with the dose in milligrams and in millilitres of the specific product they hold, the interval, the maximum in 24 hours, and the date to stop - written, not said.
- Prescribe in milligrams per kilogram with the current weight, and write the millilitre dose for the specific product family will use
- Prescribe regularly, not as required, for the first 48 hours after a painful procedure
- Write the maximum dose in 24 hours, and ask specifically about combination preparations at home
- Put a review or stop date on the prescription
- Re-weigh rather than reusing an admission weight for a child whose stay has been long
Why it matters
The commonest reason a child's pain is poorly controlled is the prescription, not the pharmacology.
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