The Institute for Safe Medication Practices (ISMP) has issued a warning about medication errors when multiple dosing methods are used for the same drug. For example, calcium gluconate may be ordered as mcg/kg/hour, mg/kg/hour, mEq/kg/hour, and mg/minute, among others. One recent study found that almost 30% of prescribing errors involved the wrong dose method, especially with pediatric patients. In other cases, the prescribed dose method was correct but the wrong dose method was selected on the infusion pump.
   To help reduce such errors, ISMP recommends the following:

• Standardize dose methods whenever possible.
• Use smart pumps equipped with error-reduction software, and follow up on all pump alerts.
• Display the drug's dose on the drug label and the medication administration record the same way it's needed to program the pump.
• Especially for error-prone drugs (such as chemotherapy drugs and pediatric dosages), prescribers should list the dose specification along with the calculated dose. Nurses should then verify both the method and the calculated dose.
• Have a second nurse verify pump settings when infusing error-prone drugs, changing infusion rates, transferring the patient, and changing shifts.
• Make sure the dosing method and total dose make sense for the patient's age, weight, and condition.
• If the patient isn't responding appropriately, consider and investigate a possible medication error.

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