Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP.

Mark X. Cicero; Kathleen Adelgais; John D. Hoyle; John W. Lyng; Matthew Harris; Brian Moore

Organizational Policy/Guidelines

Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP.

August 26, 2020

Cicero MX, Adelgais K, Hoyle JD, et al. Prehosp Emerg Care. 2020;25(2):294-306.

View more articles from the same authors.

This position statement shares 11 recommendations drawn from a review of the evidence to improve the safety of pediatric dosing in pre-hospital emergent situations. Suggestions for improvement include use of kilograms as the standard unit of weight, pre-calculated weight-based dosing, and dose-derivation strategies to minimize use of calculations in real time.

PubMed citation

Available at

Related Resources From the Same Author(s)

Methods used to obtain pediatric patient weights, their accuracy and associated drug dosing errors in 142 simulated prehospital pediatric patient encounters.

August 25, 2021

An analysis of prehospital pediatric medication dosing errors after implementation of a state-wide EMS pediatric drug dosing reference.

March 1, 2023

Pediatric prehospital medication dosing errors: a national survey of paramedics.

March 29, 2017

Pediatric prehospital medication dosing errors: a mixed-methods study.

November 11, 2015

A standardized formulary to reduce pediatric medication dosing errors: a mixed methods study.

October 6, 2021

Optimizing Pediatric Patient Safety in the Emergency Care Setting.

October 19, 2022

Intraoperative sentinel events in the era of surgical safety checklists: results of a national survey.

March 3, 2021

Retrospective review for medication dose errors in pediatric emergency department medication orders that bypassed pharmacist review.

March 25, 2020

Shame and guilt in EMS: a qualitative analysis of culture and attitudes in prehospital emergency care.

July 13, 2022

Factors influencing medication errors in the prehospital paramedic environment: a mixed method systematic review.

July 27, 2022

Safeguarding patients: complexity science, high reliability organizations, and implications for team training in healthcare.

December 20, 2006

Identification of adverse events in ground transport emergency medical services.

September 14, 2011

Paramedic self-reported medication errors.

October 18, 2006

Frequency, type, and degree of potential harm of adverse safety events among pediatric emergency medical services encounters.

November 1, 2023

Problems in care and avoidability of death after discharge from intensive care: a multi-centre retrospective case record review study.

February 10, 2021

Transitions from one electronic health record to another: challenges, pitfalls, and recommendations.

December 16, 2020

Adverse events related to accidental unintentional ingestions from cough and cold medications in children.

August 26, 2020

Effectiveness of acute care remote triage systems: a systematic review.

February 5, 2020

Association of patient and family reports of hospital safety climate with language proficiency in the US.

June 29, 2022

An analysis of the structure and content of dashboards used to monitor patient safety in the inpatient setting.

December 8, 2021

Variability in collection and use of race/ethnicity and language data in 93 pediatric hospitals.

October 14, 2020

COVID-19: an emerging threat to antibiotic stewardship in the emergency department.

October 21, 2020

Clinical data sharing improves quality measurement and patient safety.

March 24, 2021

A mixed methods evaluation of medication reconciliation in the primary care setting.

March 2, 2022

Medication errors in overweight and obese pediatric patients: a systematic review.

February 9, 2022

Incoming interns recognize inadequate physical examination as a cause of patient harm.

July 15, 2020

EMS non-conveyance: a safe practice to decrease ED crowding or a threat to patient safety?

October 27, 2021

Antibiotic prescribing errors in patients discharged from the pediatric emergency department.

March 30, 2022

Patient Safety in Ambulance Services: A Scoping Review.

June 10, 2015

"Good catch, Kiddo"--enhancing patient safety in the pediatric emergency department through simulation.

December 9, 2020

Creating psychological safety in interprofessional simulation for health professional learners: a scoping review of the barriers and enablers.

May 18, 2022

Linking patient safety culture to quality ratings in the nursing home setting.

December 9, 2020

Are opioid infusions used inappropriately at end of life? Results from a quality/safety project.

July 20, 2022

Diagnostic error in the pediatric hospital: a narrative review.

February 9, 2022

Assessing quality of older persons' emergency transitions between long-term and acute care settings: a proof-of-concept study.

May 18, 2022

Pediatric trainees' speaking up about unprofessional behavior and traditional patient safety threats.

September 30, 2020

Design and implementation of an analgesia, sedation, and paralysis order set to enhance compliance of pro re nata medication orders with Joint Commission medication management standards in a pediatric ICU.

December 9, 2020

September 15, 2021

Delay or avoidance of medical care because of COVID-19-related concerns--United States, June 2020.

October 7, 2020

Healthcare worker serious safety events: applying concepts from patient safety to improve healthcare worker safety.

August 4, 2021

Patients' perceptions of safety in emergency medical services: an interview study.

December 2, 2020

Care quality, patient safety, and nurse outcomes at hospitals serving economically disadvantaged patients: a case for investment in nursing.

January 19, 2022

Patient perceptions of safety in primary care: a qualitative study to inform care.

October 13, 2021

Improving discharge safety in a pediatric emergency department.

October 26, 2022

Preventing patient positioning injuries in the nonoperating room setting.

August 24, 2022

Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review.

June 30, 2021

When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship.

June 15, 2016

Missing the near miss: recognizing valuable learning opportunities in radiation oncology.

December 16, 2020

Bringing the clinical laboratory into the strategy to advance diagnostic excellence.

September 22, 2021

Implementing universal suicide risk screening in a pediatric hospital.

August 18, 2021

Preventing home medication administration errors.

March 14, 2022

Electronic medical record-based interventions to encourage opioid prescribing best practices in the emergency department.

September 30, 2020

A qualitative exploration of mental health service user and carer perspectives on safety issues in UK mental health services.

August 5, 2020

A systematic review of the effect of telepharmacy services in the community pharmacy setting on care quality and patient safety.

June 30, 2021

"At home, with care": lessons from New York City home-based primary care practices managing COVID-19.

December 16, 2020

Safety checklists for emergency response driving and patient transport: experiences from emergency medical services.

July 7, 2021

Human factors analysis of latent safety threats in a pediatric critical care unit.

May 18, 2022

Learning from diagnostic errors to improve patient safety when GPs work in or alongside emergency departments: incorporating realist methodology into patient safety incident report analysis.

January 12, 2022

Perceptions of nurses who are second victims in a hospital setting.

December 22, 2021

Associations between safety outcomes and communication practices among pediatric nurses in the United States.

January 19, 2022

Comparison of a focused family cancer history questionnaire to family history documentation in the electronic medical record.

March 16, 2022

Coping with errors in the operating room: intraoperative strategies, postoperative strategies, and sex differences.

September 22, 2021

NHS ‘Learning from Deaths’ reports: a qualitative and quantitative document analysis of the first year of a countrywide patient safety programme.

July 21, 2021

The Lancet Commission on lessons for the future from the COVID-19 pandemic.

October 12, 2022

Providers' and patients' perspectives on diagnostic errors in the acute care setting.

February 15, 2023

Pediatric transport safety collaborative: adverse events with parental presence during pediatric critical care transport.

November 10, 2021

Effect of cognitive aids on adherence to best practice in the treatment of deteriorating surgical patients: a randomized clinical trial in a simulation setting.

January 8, 2020

Implicit bias and caring for diverse populations: pediatric trainee attitudes and gaps in training.

September 22, 2021

February 2, 2022

How patients perceive a doctor's caring attitude.

September 24, 2008

Increasing physician reporting of diagnostic learning opportunities.

December 23, 2020

Reducing pediatric emergency department prescription errors.

June 22, 2022

Prevalence, nature and predictors of omitted medication doses in mental health hospitals: a multi-centre study.

March 11, 2020

What contributes to diagnostic error or delay? A qualitative exploration across diverse acute care settings in the United States.

May 26, 2021

A review of adverse event reports from emergency departments in the Veterans Health Administration.

March 18, 2020

Structural racism and the COVID-19 experience in the United States.

July 7, 2021

'It depends': The complexity of allowing residents to fail from the perspective of clinical supervisors.

November 24, 2021

SAFER Care: improving caregiver comprehension of discharge instructions.

March 31, 2021

Adverse drug event-related admissions to a pediatric emergency unit.

April 14, 2021

Crowding in the Emergency Department: Challenges for the Care of Children.

March 15, 2023

CancelRx: a health IT tool to reduce medication discrepancies in the outpatient setting.

September 1, 2021

How accurately do older adult emergency department patients recall their medications?

August 12, 2020

Interprofessional/interdisciplinary teamwork during the early COVID-19 pandemic: experience from a children's hospital within an academic health center.

August 12, 2020

Analyzing diagnostic errors in the acute setting: a process-driven approach.

October 20, 2021

Incidence of prescription errors in patients discharged from the emergency department.

September 22, 2021

From principles to practice: embedding clinical reasoning as a longitudinal curriculum theme in a medical school programme.

June 15, 2022

Rating the raters: an evaluation of publicly reported hospital quality rating systems.

September 4, 2019

Interventions to reduce medication dispensing, administration, and monitoring errors in pediatric professional healthcare settings: a systematic review.

September 29, 2021

A scoping review of adverse incidents research in aged care homes: learnings, gaps, and challenges.

February 8, 2023

Crowd-sourced hospital ratings are correlated with patient satisfaction but not surgical safety.

June 9, 2021

A handoff protocol from the cardiovascular operating room to cardiac ICU is associated with improvements in care beyond the immediate postoperative period.

July 17, 2013

Distractions in the operating room: a survey of the healthcare team.

April 5, 2023

Closing the loop on test results to reduce communication failures: a rapid review of evidence, practice and patient perspectives.

November 25, 2020

Lifetime prevalence and correlates of patient-perceived medical errors experienced in the U.S. ambulatory setting: a population-based study.

November 18, 2020

Pediatric musculoskeletal radiographs: anatomy and fractures prone to diagnostic error among emergency physicians.

August 3, 2022

Identifying hot spots for harm and blind spots across the care pathway from patient complaints about general practice.

November 3, 2021

May 5, 2021

Prehospital naloxone and emergency department adverse events: a dose-dependent relationship.

November 25, 2020

Impact of pharmacist interventions on medication errors in hospitalized pediatric patients: a systematic review and meta-analysis.

October 14, 2020

Clinical predictors for unsafe direct discharge home patients from intensive care units.

October 21, 2020

Related Resources

An integrative systematic review of promoting patient safety within prehospital emergency medical services by paramedics: a role theory perspective.

April 17, 2024

Targeted Medication Safety Best Practices for Hospitals.

February 22, 2024

Society of Critical Care Medicine Guidelines on Recognizing and Responding to Clinical Deterioration Outside the ICU: 2023.

February 7, 2024

Adverse safety events in emergency medical services care of children with out-of-hospital cardiac arrest.

January 31, 2024

Validation and use of the Second Victim Experience and Support Tool questionnaire: a scoping review.

December 20, 2023

Measurement of ambulatory medication errors in children: a scoping review.

December 13, 2023

Frequency, type, and degree of potential harm of adverse safety events among pediatric emergency medical services encounters.

November 1, 2023

A scoping review exploring the confidence of healthcare professionals in assessing all skin tones.

October 4, 2023

Compendium of Strategies to Prevent HAIs in Acute Care Hospitals 2022.

September 11, 2023

Weight estimation for drug dose calculations in the prehospital setting - a systematic review.

September 6, 2023

Harm Caused by Delays in Transferring Patients to the Right Place of Care.

September 6, 2023

American Geriatrics Society 2023 updated AGS Beers Criteria for Potentially Inappropriate Medication Use in Older Adults.

August 16, 2023

Improving emergency medicine clinician awareness of prehospital-administered medications.

August 9, 2023

Factors influencing the perception of feeling safe in pre-hospital emergency care: a mixed-methods systematic review.

August 9, 2023

Meta-analysis of medication administration errors in African hospitals.

August 2, 2023

WebM&M Cases

Under Pressure: Tracheostomy Cuff Over Inflation Leading to Tissue Necrosis and Cuff Rupture.

June 28, 2023

Interorganizational health information exchange-related patient safety incidents: a descriptive register-based qualitative study.

May 24, 2023

The effect of documenting patient weight in kilograms on pediatric medication dosing errors in emergency medical services.

May 3, 2023

Crowding in the Emergency Department: Challenges for the Care of Children.

March 15, 2023

Ten years of online incident reporting and learning using CPiRLS: implications for improved patient safety.

March 15, 2023

NHS staff cried in safety interviews, says watchdog.

March 8, 2023

An analysis of prehospital pediatric medication dosing errors after implementation of a state-wide EMS pediatric drug dosing reference.

March 1, 2023

'They were his best shot. And they failed to help’: why did EMS workers neglect Tyre Nichols?

February 15, 2023

Self-assessment and learning motivation in the second victim phenomenon.

February 1, 2023

Preventing medication errors in pediatric anesthesia: a systematic scoping review.

November 9, 2022

Frailty and potentially inappropriate prescribing in older people with polypharmacy: a bi-directional relationship?

August 31, 2022

WebM&M Cases

EMS Perils from Hospital Overcrowding

August 31, 2022

Factors influencing medication errors in the prehospital paramedic environment: a mixed method systematic review.

July 27, 2022

Can a targeted educational approach improve situational awareness in paramedicine during 911 emergency calls?

June 8, 2022

Reasons for bias in ambulance clinicians' assessments of non-conveyed patients: a mixed-methods study.

May 25, 2022

See More About The Topic

Patient Transport

Allied Health Professionals

Quality and Safety Professionals

Allied Health Services

Medication Safety

Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Medication dosing safety for pediatric patients: recognizing gaps, safety threats, and best practices in the emergency medical services setting. A position statement and resource document from NAEMSP.

Connect With Us

Sign up for Email Updates

Agency for Healthcare Research and Quality

Submit Your Innovations

Continue as a Guest

Continue Logged In

Submit Your Innovations

Continue as a Guest

Continue logged in

New Users to the PSNet site