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Subtract rule of six from hospital's medication dosing equations

Pharmacy Regulation Resource, July 28, 2004

JCAHO National Patient Safety Goal #3b requires you to standardize and limit the number of drug concentrations available in the organization. Using an equation such as the rule of six hinders compliance with this goal, according to the JCAHO.

The rule of six-typically used for pediatric patients-is a formula that multiplies the patient's weight by six, which equals the drug amount in milligrams that should be added to 100 milliliters of solution. The dose ordered in micrograms per kilograms per minute equals the infusion volume in milliliters per hour.

The formula creates a problem because the solution concentration could change with each patient, leading to potential calculation mistakes and other errors.

"One of the best things to do to prevent errors is to standardize the concentrations of drugs you give," says Matthew Grissinger, RPh, FASCP, a medication safety analyst with the Institute for Safe Medication Practices. "When you use the rule of six, you're not standardizing the concentrations."

Tip: Create a dosage chart based on standardized concentrations and patient weight. Adjust the dose accordingly to the weight range.

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