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5 ways to eliminate dosing errors

Remain consistent once you’ve established the patient’s weight, ensure you know what’s in your containers and practice dosing calculations to prevent medication administration errors


It’s all too easy to see how calculations can be complicated in an emergency response. Put yourself in a cardiac arrest situation.

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Medication dose miscalculations can have serious, potentially fatal consequences, especially in the pediatric patient population, in which dose calculation errors are the most common type of medication errors. It’s all too easy to see how calculations can be complicated in an emergency response. Put yourself in a cardiac arrest situation. To complicate things, let’s make it a pediatric cardiac arrest scenario.

Your patient is a 10-year-old male who suddenly collapsed during gym class. You arrive at a playground where school staff are performing chest compressions and have just used an AED to deliver a shock.

You resume compressions, ventilate, establish IO access, and are ready to administer your first dose of epinephrine 1:10,000.

0.01 mg/kg ... times 32 kg ... then carry the one ... move the decimal point ... divide by pi...

Drawing and administering medications comes with its own set of risks and potential pitfalls. Reducing dosing errors is just one way that we can reduce such risks, especially important in the pediatric population. Here are five steps to reducing dosing errors.

1. Remain consistent

If you’re determining your pediatric patient to be 32kg, then broadcast it. Make sure everyone involved in treating the patient is aware of what weight you’re basing your calculations on and remain consistent in your dosing. Don’t switch between 30 kg and 35 kg doses. You established the patient to be 32 kg, so stick with it!

2. Read your containers

Whether you’re drawing medication from a vial, ampule or pre-filled syringe, read your container to verify that your reference devices match the concentration. A 1 mg/1 mL vial will result in a different volume than a 1 mg/10 mL syringe.

Pre-planning at the beginning of your shift will alert you to any container changes that might have occurred since your last encounter with this medication. As medication shortages continue to impact our industry, changes in container volumes will inevitably have an impact on how we dose our medications.

3. Measure twice, draw once

Utilize references to your advantage. Be aware of their strengths, as well as their weaknesses. Not all reference devices break your administration volume down to milliliters (which simply makes our jobs easier). To reduce the risk of error, two providers should utilize two different reference devices.

4. Label your syringe

If you’re transferring medications from a 10 mL syringe to a 3 mL syringe, it may be beneficial to label your syringe – both with the medication that you’re drawing – and with the actual volume amount to draw. Another option is utilizing commercially pre-labeled syringes that correlate to a patient’s weight-based color-code.

5. Practice medication dosing often

Whether you administer medications every shift or not, it’s important to keep your mind on track and ready to calculate formulas, as well as familiarize yourself with your equipment on a regular basis.

If you’re an EMS educator, quiz your students on medication doses at the beginning of every session. Give them a container and a dose, then have them calculate the milliliters to draw.

If you’re going through your rig checks, run through the doses in your head. Recite which volume you would draw and where you would find the necessary equipment. Where is your 3 mL syringe ... or your blunt-tip needle ... or filter straw? Practice doesn’t necessarily make you perfect, but it will make you consistent!

Set yourself and your agency up for success. Practice your skills, refine your processes and minimize your opportunity for error. Following these simple steps can help to prevent dosing errors.

Drug calculation resources

This article, originally published September 25, 2018, has been updated.

Tim is the founder and CEO of Emergency Medical Solutions, LLC, an EMS training and consulting company that he developed in 2010. He has nearly two decades of experience in the emergency services industry, having worked as a career firefighter, paramedic and critical care paramedic in a variety of urban, suburban, rural and in-hospital environments. His background includes nearly a decade of company officer and chief officer level experience, in addition to training content delivery and program development spanning his entire career. He is experienced in EMS operations, community paramedicine, quality assurance, data management, training, special operations and administration disciplines, and holds credentials as both a supervising and managing paramedic officer.

Tim also has active experience as a columnist and content developer with over 200 published works and over 100 hours of education content available online, and is a social media influencer on LinkedIn within the EMS industry. Connect with him on LinkedIn or at