By: Manoj M. Lalu, MD, PhD
Pediatric dosing of therapeutics can be a confusing affair at the best of times — especially for those of us who don’t provide care for children on a regular basis.
Even ten fold medication errors can be easily made when dealing with extremely small volumes of medication (“death by decimal point”).
Moreover, it is not uncommon for the concentration of stock medication to be changed – potentially leading to even more errors. Safe Dose is an app that addresses these problems in an easy to use format. Of note, Dr. James Broselow (of the “Broselow Tape” that is widely used for pediatric trauma and resuscitation) is behind this app.
The opening screen brings you to a menu where you can select your patient by weight or by Broselow tape color. The selection of weight ranges from 3 kg to only 36 kg.
Alternatively, medications can be listed alphabetically, by broad categories, or searched by name. The alphabetical listing notably supports both trade and generic names (e.g. Zemuron and Rocuronium).
Recently viewed medications can be recalled quickly from the last link on the front-page menu.
If you select a weight and then a medication it brings you an information screen. Various available concentrations of a medication are shown in table format along with the weight-adjusted volume to be administered.
Thus, as long as the weight and indication (i.e. sedation vs. induction) selected are correct, no further calculations are needed. Under stressful circumstances this would definitely be a valuable feature!
Under the dosing table, essential information for drug administration is listed. I particularly liked that only critical information is listed here for each drug.
A final feature of this app worth expanding on is the “By Category” selection from the opening menu. Within this section you can select from a broad number of problems/indications for medication.
Choosing one of these indications brings you to a sub-section where various drugs are listed by type. For instance, under Rapid Sequence Induction (“RSI”), pre-treatment, paralytic and induction agents are listed. Obviously, some familiarity with the medications is necessary as no guidance is given on which medications to select (e.g. RSI with the pancuronium or vecuronium options listed would definitely not be ‘rapid’!).
Another oddity I found in the RSI section was that endotracheal tube size was listed in “Post-Intubation Management”. This information should probably be listed in its own category prior to any induction drugs.
Overall, I found Safe Dose to be a useful app during my last rotation through Pediatric Anesthesia. Undoubtedly, the potential for medication errors would be reduced if practitioners were to rely on the information provided by this app (or similar apps).
One addition that would make the app even more useful would be a “Favorites” category where you could list your frequently used drugs.
In general, though, I think anyone who directly administers drugs to pediatric patients (anesthesiologists, emergency medicine physicians, nurses, paramedics) will find this app potentially useful.
- Well laid out app, easy to read and follow
- No calculations required – final volumes of medications listed
- Trade and generic names listed
- No method to create a list of frequently used drugs
- Limited weight selection
- ETT size selection is hidden in post-intubation management category
- No guidance for drug selection given within the “By Category” section
- A useful and well designed calculator app for pediatric therapeutics