- Appreciate that because of multiple factors, children are at high risk for medical errors.
- Describe the importance of weight-based dosing of medications and fluids in pediatrics.
- Describe how the inability to communicate clearly can place pediatric patients at risk for medical errors or unsafe care.
- List two interventions that may help providers more safely care for pediatric patients.
A 22-month-old infant was admitted to the hospital in the late afternoon with a viral infection. He had a complex past medical history including congenital heart disease, poor feeding requiring a gastric tube, and delayed cognitive development. At the time of admission, he was moderately ill appearing but remained interactive with his mother and hospital staff. He was given appropriate therapies for his viral infection.
Later in the evening, the infant drank 2 ounces (60 mL) of a liquid nutritional drink and then went to sleep; this was the sum total of his fluid consumption since hospital admission. The child slept well and in the morning his vital signs were all normal. He remained interactive but seemed a bit sleepy. His total urine output overnight as documented by the nurse was 50 mL (a low urine output given his weight of 10 kg). The night nurse communicated the minimal intake of fluids and poor urine output to the day nurse at the 7:00 AM change of shift.
The day nurse, busy caring for other patients, failed to appreciate the significance of the low intake and output. Over the next few hours, the infant became more somnolent and less responsive. His aunt assumed this was due to the viral infection, and the child was not evaluated by the nurse during this time. When his mother returned in the early afternoon, she found her son to be lethargic and acting strangely. Evaluation by the intern revealed a low blood pressure, high heart rate, decreased muscle tone, and decreased responsiveness to stimulation. Stat labs revealed severe hypoglycemia and dehydration. The infant was transferred to the pediatric intensive care unit where an IV was placed and he was given intravenous fluids and intravenous glucose. He required 2 days in the intensive care unit but did not experience any long-term consequences.
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Figure. Sample Pediatric Early Warning Score Card. A child is felt to be at risk if score is ≥ 4 points total or ≥ 3 points in any of the three main domains (behavior, cardiovascular, respiratory).
Click to enlarge.