Medication Errors in Pediatric Patients

The Institute for Safe Medication Practices (ISMP) joined with the Pediatric Pharmacy Advocacy Group to survey hospitals about medication safety practices for pediatric patients in critical care and noncritical care units. The results appeared in the April 19, 2000 issue of “ISMP Medication Safety Alert.”

According to the ISMP survey results, greater precautions are necessary to protect pediatric patients from potentially tragic medication errors. While many safety practices are used fairly consistently, other important safeguards, such as inclusion of the mg per kg dose on all pediatric medication orders, are greatly underused. Approximately 75 percent of all survey respondents said that prescribers often or consistently failed to include the mg per kg dose on pediatric medication orders.

The survey results showed that about 33 percent of respondents from neonatal intensive care units (NICU) and pediatric intensive care units (PICU) reported little or no involvement by clinical pharmacists in these high-risk patient care units.

The ISMP also asked about specialized training for health care professionals who prepare pediatric parenteral solutions. Nearly 90 percent of NICU and PICU respondents said that specialized training was required for pediatric nurses. However, only 66 percent of respondents from general practice units had similar training requirements.

For more information on the prevention of medication errors, write to ISMP, P.O. Box 328, Fulton, MD 20759-0328 or call 301-497-2375. Survey results are also available on the ISMP Web site athttp://www.ismp.org.

Education of Children with HIV Infection

The Committee on Pediatric AIDS of the American Academy of Pediatrics (AAP) has released a position statement on the education of children with human immunodeficiency virus (HIV) infection. The AAP statement appears in the June 2000 issue of Pediatrics.

According to the AAP committee, fear of the communicability of HIV must be allayed by appropriate education of all school personnel. Participation in school provides a sense of normalcy for children and adolescents with HIV infection and offers important opportunities for socialization. School attendance provides HIV-infected children with a sense of belonging and reduces feelings of isolation and rejection.

The AAP statement discusses HIV infection and developmental delay, federal disabilities rights laws, management of HIV in the school setting, home instruction, confidentiality and exposure to illness.

The AAP committee makes the following recommendations about education of children with HIV infection:

• All children and adolescents with HIV infection should have the same right as those without infection to attend school and receive high-quality educational services.

• Children and adolescents with HIV infection should be given access to special education and other related services in accord with their needs as the disease progresses.

• Mechanisms for administration of medications, including confidential methods for HIV infection, should be in place in all schools. This includes appropriate facilitation of specific needs for fluids or bathroom privileges.

• Continuity of education should be ensured for children and adolescents with HIV infection and should include traditional school, medical day treatment programs and home schooling.

• Confidentiality of HIV infection status should be respected and maintained, with disclosure given only with the consent of parent(s) or legal guardian(s) and age-appropriate assent of the student.

• The physician should maintain appropriate communication with the school to facilitate the education of children in their care.

FDA Approval of New Indication for Oseltamivir

The U.S. Food and Drug Administration (FDA) has approved a new indication for oseltamivir (Tamiflu), a neuraminidase inhibitor previously approved for the treatment of uncomplicated influenza in adults. Oseltamivir is now approved for the prevention of influenza in adults and children 13 years and older.

In one study of healthy unvaccinated adults and adolescents, oseltamivir in a dosage of 75 mg once daily taken for 42 days during a community outbreak reduced the incidence of clinical influenza from 4.8 percent in the placebo group to 1.2 percent in the oseltamivir group. Results of another study showed that 75 mg of oseltamivir taken once daily within two days of the onset of influenza symptoms and continued for seven days reduced the incidence of clinical influenza from 12 percent in the placebo group to 1 percent in the oseltamivir group.

The most common side effects of oseltamivir, when used for the prevention of influenza, include nausea, vomiting, headache and fatigue. These side effects are similar to those experienced by patients who took the drug for the treatment of influenza. The efficacy of oseltamivir for the prevention of influenza has not been established in patients who are immunocompromised.

According to guidelines on immunization practices, patients should continue to receive annual influenza vaccination. For more information on this new indication for oseltamivir, call 888-INFO-FDA (888-463-6332).

Prevention of All-Terrain Vehicle Injury

The Committee on Injury and Poison Prevention of the American Academy of Pediatrics (AAP) has issued a statement on public, patient and parent education about the prevention of injury from all-terrain vehicle (ATV) use in children. The purpose of this statement, which appears in the June 2000 issue of Pediatrics, is to update and strengthen previous AAP policy.

The AAP committee recommends that young patients and their parents be educated about the dangers of all types of ATVs. During routine office visits, families should be asked about the types of recreational activities in which they participate. According to the AAP committee, the following points should be emphasized:

• Off-road vehicles are especially dangerous for children younger than 16 years who may have immature judgment and motor skills.

• Because injuries often occur to passengers, riding double should not be permitted.

• All riders should wear helmets, eye protection and protective reflective clothing.

• Parents should never allow off-road vehicles to be used on the street or at night.

• Flags, reflectors and lights should be used to make vehicles more visible.

• Persons who have consumed alcohol should not drive; parents should set an example for their children.

• Young drivers should be discouraged from on-road riding of any two-wheeled motorized cycle, even if they have a license, because they are more dangerous than passenger cars.

The AAP statement also recommends that ATVs be modified for safety and that laws be passed in all states regarding the safe operation of ATVs and the development and improvement of safer off-road trails.

New Guide Provides Spanish-Speaking Patients with Disease and Health Care Information

The Agency for Healthcare Research and Quality (AHRQ) has released a new guide to help Spanish-speaking patients find reliable information about disease and the benefits and risks of available treatments. The Spanish language publication, “Le han diagnosticado: ¿Qué es lo que sigue?” is also available in English, titled “Now You Have a Diagnosis: What's Next?”

The guide explains different types of health care studies and what research can reveal about treatments; how to get support from others; and how to work with one's physician to develop a treatment plan. AHRQ stresses that patients need to know as much as possible about their diagnosis and understand the benefits and risks of available treatment options. Organizations such as employers and health insurance companies would benefit by making the guides available to their members.

For a copy of the guide (AHRQ Publication No. 00-0038), contact the AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907 or call 800-358-9295. The Spanish language version is available on the AHRQ Web site athttp://www.ahrq.gov/consumer/spdiagn/spdiagn.htm. The English language version is available athttp://www.ahrq.gov/consumer/diaginfo.htm.

ACSM Statement on Exercise and Type 2 Diabetes

The American College of Sports Medicine (ACSM) has released a position stand on exercise and type 2 diabetes (formerly known as non–insulin-dependent diabetes). The statement covers the positive therapeutic benefits of exercise, resistance training and flexibility training in persons with diabetes. The ACSM statement appears in the July 2000 issue of Medicine & Science in Sports & Exercise.

According to the ACSM position stand, 10.3 million cases of type 2 diabetes have been diagnosed and nearly 5 million additional undiagnosed cases exist. The goal of treatment of type 2 diabetes should be the achievement and maintenance of normal or near-normal blood glucose levels and optimal lipid levels. The degree of blood glucose level control in obese patients with type 2 diabetes seems to be directly proportional to the amount of physical activity the patient performs. The effects are not as clear for the non-obese patient.

The ACSM makes the following recommendations about exercise for patients with type 2 diabetes:

• Persons with diabetes or who are pre-disposed to the disease should be screened and advised by a physician and a physical activity program should be developed.

• In patients with type 2 diabetes, the goal for energy expenditure should be a minimum of 1,000 calories per week.

• Persons with diabetes should participate in at least three nonconsecutive days of exercise per week, for 10 to 15 minutes per session at 45 to 70 percent maximum heart rate.

• The rate of progression of intensity should depend on the patient's age, functional capacity, medical status and personal goals.

For a copy of the position stand, visit the ACSM Web site athttp://www.acsm.org.

NIAMS Releases Booklet on Ways to Find Medical Information

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) has published a booklet titled “How to Find Medical Information.” The free 20-page booklet provides information on how to use various resources to find answers to medical questions.

The booklet offers ideas such as starting with a community library, taking advantage of services provided by the federal government and other organizations, finding a medical library, using telephone and fax services, exploring computer databases and searching the Internet. The booklet also discusses how to use information wisely and how to make informed decisions about health care by understanding your health problem.

For a copy of “How to Find Medical Information,” or for more information on arthritis and musculoskeletal and skin diseases, write to the NIAMS Information Clearinghouse, 1 AMS Circle, Bethesda, MD 20892-3675; call 877-22NIAMS; fax 301-718-6366; or e-mail atniamsinfo@mail.nih.gov. The booklet is also available on the NIAMS Web site athttp://www.nih.gov/niams/healthinfo/howto.htm.

Mifepristone Approved for Use in the United States

The U.S. Food and Drug Administration (FDA) has approved mifepristone (Mifeprex) for the termination of early pregnancy, which is defined as 49 days or less, counting from the beginning of the last menstrual period. Known in Europe as RU-486, the drug has been available for more than 10 years, but has just been approved for use in the United States.

Mifepristone is a synthetic steroid that interferes with the ability of a fertilized egg to adhere to the uterine lining. To cause termination of pregnancy, the drug is used early in pregnancy with another drug, misoprostol, to prompt uterine contractions. Mifepristone can be given in a physician's office.

The cost of using mifepristone is expected to be about $300. Side effects include cramping and bleeding, which in some women may become heavy enough to require a surgical procedure. The drug's labeling warns that it should not be used in women with the following conditions: confirmed or suspected ectopic pregnancies; intrauterine device in place; chronic failure of the adrenal glands; current long-term corticosteroid therapy; history of allergy to mifepristone, misoprostol or other prostaglandins; and bleeding disorders or current anticoagulant therapy.