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Weight-based Medication Errors in Children.

Farnborough, UK: Healthcare Safety Investigation Branch; February 2, 2022.

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February 16, 2022

Farnborough, UK: Healthcare Safety Investigation Branch; February 2, 2022.

Weight-calculation errors can result in pediatric patient harm as they affect medication prescribing, dispensing, and administration accuracy. This report examines factors contributing to a computation mistake that resulted in a child receiving a 10-fold anticoagulant overdose over a 3-day period. Areas of focus for improvement include use of prescribing technology, and the double-check as an error barrier.