However, prescribing appropriate doses of drugs requiring weight-based dosing is still challenging due to poor awareness and adherence.
#Accurate 5 kg weight software#
1 Organizations must strive for strategies that achieve goals such as establishing processes for weighing and weight documentation, requiring pharmacy review of weight-based dosing regimens, ensuring sufficient and convenient availability of appropriate and properly functioning equipment for patient weighing and medication delivery, and using health information technology and clinical decision support software to promote safe and appropriate dosing. Clinicians should consider writing weight-adjusted orders whenever possible. Joint Commission International (JCI) Accreditation Standards for Hospitals (5th edition) requires that the hospital policy should specify the weight-based dosing strategy in the particular circumstance (eg, pediatric patients, frail elderly patients). However, for the sake of safety and efficacy, weight-based dosing method is needed for particular population and also specified in prescribing information for many medications. Generally, fixed-dosing regimen is potentially more convenient than weight-adjusted dosing regimen for both patients and clinicians. Effective weight-based dosing interventions include standardization of weight estimation, documentation and dosing determination, dosing chart, dosing protocol, order set, pharmacist participation, technological information, and educational measures. The common viewpoint (ie, pediatric patients should be dosed on the basis of body weight) is not always correct. Dosing guided by pharmacogenetic testing did not show pharmacoeconomic advantage over weight-adjusted dosing of 6-mercaptopurine. Age-based dosing strategy is better than weight-based dosing in some cases (eg, intravenous busulfan and dalteparin). For dosing in pediatrics, whether weight-based dosing is better than body surface-area-based dosing is dependent on the particular medication (eg, methotrexate, prednisone, prednisolone, zidovudine, didanosine, growth hormone, and 13- cis-retinoic acid). Ideal body-weight-based dosing may be superior to the currently recommended total body-weight-based regimen (eg, atracurium and rocuronium).
On the contrary, fixed dosing is noninferior to or even better than currently recommended weight-based regimen in adult patients in some cases (eg, cyclosporine microemulsion, recombinant activated Factor VII, and epoetin α). In some cases, weight-based dosing is superior to currently recommended fixed-dose regimen in adult patients (eg, hydrocortisone, vancomycin, linezolid, and aprotinin). Medications within similar therapeutic or structural class (eg, anticoagulants, antitumor necrosis factor medications, P2Y12-receptor antagonists, and anti-epidermal growth factor receptor antibodies) may exhibit differences in requirements on weight-based dosing. In some cases, the weight effect may be minimal or the proper dosage can only be determined when weight is combined with other factors. Clinical indications, physiological factors, and types of medication may determine the applicability of weight-based dosing.
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