227 Mind the gap!! uncommon cause of high anion gap metabolic acidosis due to pyroglutamic acidosis (PGA)

Alagusutha Jeyaraman, Neil Wright, Marta Cohen
2021 Abstracts   unpublished
in Malta, were analysed for sources of error. The British National Formulary for Children (BNFC) was used to establish the correct prescribing standard. Methods Treatment charts of all admissions to medical paediatric inpatient wards were reviewed daily over a fourweek period. Prescriptions for Paracetamol were assessed for legibility, inedibility, approved drug nomenclature, correct dose and dosing frequency, approved dosing interval abbreviations, writing of minimum dosing interval for pro re
more » ... nata (PRN), appropriate dating, prescriber signature and prescriber designation. Treatment charts were also analysed to assess accurate writing of patient name, identification number, age, date of birth, height, weight, and allergies. Paracetamol prescriptions for indications other than fever were excluded. Results A total of 72 treatment charts were analysed of which 44 contained Paracetamol prescriptions. Age ranged from 1 day to 13 years. 93.2% of all prescriptions were on a PRN basis. Legibility and inedibility met the BNFC standard in 100% of cases. Approved drug nomenclature was used in 97.7% of prescriptions. With regards to dosing, 54.5% of prescriptions did not follow the standard leading to incorrect dosing. Of these cases, 50% were due to the same dose of Paracetamol being prescribed for the oral, intravenous and rectal routes used for the same child. In the other 50%, the oral dose was calculated by weight instead of using fixed dose ranges based on age. Where errors were made, patients were overdosed by an average of 20% more than the recommended maximum dose. Correct dosing frequency was present in 100% of cases. 97.7% of dosing interval abbreviations were not according to guidelines, mainly because English abbreviations were not written in full. PRN was not written in 51.2% of Paracetamol PRN prescriptions. Dating was correct in 95.5% of cases. Prescriber signature present in 97.7% of cases and prescriber designation in 95.5% of prescriptions.
doi:10.1136/bmjpo-2021-rcpch.124 fatcat:ameutbuzinedhnkoohrgaibygy