High Risk Medications: A PINCH

NSW Health has a great poster to highlight high risk medications.  It’s called A PINCH.

Any medications that fall into these categories are high risk and should be carefully checked by 2 nurses.  These are not the only high risk medications, of course, but these categories are the most common high risk medications in most nursing settings.

ALL medications should be carefully checked and only given by someone who knows why the patient is prescribed it, what it is for, how it is given, what it does, potential side effects, and metabolism and excretion.

Medication safety is paramount in our profession.

The One About Not Blogging Lately

It’s been a while since I wrote anything in here.  I feel somewhat remiss.

I have been working in a major metropolitan hospital for a couple years now, completed my graduate year, worked as a casual/float/reliever in any and every ward they asked me to work in and now I’m contracted in my preferred unit, the Intensive Care Unit.

I feel an enormous amount of privilege to be allowed to work where I do and with the amazing team of nurses and doctors there.

Drug calculations are part of my everyday life.  We MUST get them right.  Our patients are relying on us to be accurate and correct in our calculations.  Their lives literally depend on it.

As a student, when I developed the idea for the app, Dose Coach, I knew it was vital, but I didn’t truly grasp how fundamental to nursing it is to be able to accurately and precisely calculate drug dosages.  While most of our daily calculations are pretty straight forward, I am still amazed at how complex they can become and how precise they must be when we are titrating infusions to manage blood pressure or calculating dosage based on drops of medication.

This is why I am interested in drug calculations.  So we can be mindful of our duty of care to our patients and so we can continually improve our delivery of sometimes life-saving medications which truly makes a difference in people’s lives.

The one about the formula for tablet doses


I guess a good place to start is the basics.

The formulae for calculating medication doses are obviously a little different from each other depending on what type of medication is to be given (oral or parenteral) or if it’s an IV infusion requiring rate calculation.  For this post, I’ll just cover the basic formula for tablets.  It works the same way for other oral medications too, such as liquids.

The basics:  a/b x c = d

It’s often presented like this: dose ordered/stock on hand x volume = dose to administer

But what dose that mean?  If it’s a tablet, it goes like this (for example):

Doctor has ordered 50mg of Medication X, so that goes in ‘a’ or ‘dose ordered’.

Stock on hand is 25mg tablets of Medication X, so that goes in ‘b’ or ‘stock on hand’.

Volume in this instance is ‘tablets’ in ‘c’.

Now it looks like this: 50mg/25mg x tablets = dose to administer

so we divide the 25 into 50, getting 2, so 2 x tablets = 2 tablets

If the dose ordered had been 62.5mg, it would look like this: 62.5/25 x tab = dose, therefore 2.5 tablets.

Practicing the maths can be tricky sometimes, but the basic formula stays the same.  Once you master the formula and understand the concept, it’s just the maths.

The one about the Dose Coach launch

Dose Coach is available on iTunes!  After an initial version was uploaded, we are now launching the app for wider distribution and we hope you’ll give it a try!

Search for Dose Coach on the iTunes app store or follow the link on this page.

Screen Shots for Dose Coach

Visit Dose Coach on the App Store.

Dose Coach Starting Page

Help Screen

Help is available without a lot of math jargon.

The problem presented

See the order and the on-hand stock.

The input area

Enter the answer.

The feedback

See the feedback and repeat for practice.

Dose Coach Available on App Store

An initial version of  Dose Coach Drug Calculation Study App is ready for download.

Search for “Dose Coach” on the App Store to find and download Dose Coach.  Please send your questions or comments on Twitter @DoseCoach or as comments to the blog.

What is Dose Coach?

Dose Coach is a drug calc study app for nursing students.

It provides hundreds of oral, parenteral and drip problems and provides you immediate feedback and advice as you answer. It is designed to help you practice for that all important Drug Calc exam so that you can go in confident that you can manage the math in your head.

Dose Coach is designed knowing that you don’t go into nursing for your love of mathematics, and that practice makes perfect.

Where the idea came from

I enjoy tackling a good problem. When Sarah started her graduate entry registered nursing course @Flinders University she told me about the significant numbers of her fellow students who were concerned about and having trouble with drug calculation exams. These routine calculations need to be done correctly to ensure patients get the correct dosages of prescribed medication.

Reasonably, universities expect students to be able to pass the exams with 100 percent correct responses. Unfortunately, the math education routinely lets students down and leaves them with low confidence in their ability to pass. Research (Hodge, 2002) suggests that computers can effectively assist the third of nursing students who struggle to learn dose calculations and improve performance on exams.

What better platform for this type of practice than mobiles?

So with Sarah in school full time, I decided to take some time off my day job to put together Dose Coach, a dose calculation practice app designed to improve confidence with realistic practice problems and easy to understand advice.

This app is not designed to do the calculations, but rather to help students gain confidence in the mental arithmetic required to administer oral, parenteral and intravenous drip problems.

The one about the Injectable Drugs Handbook

When looking at a medication order, the dose ordered may require two (or more) vials of medication to make up the correct amount to administer to the patient.

There should be no guess-work involved.  The correct concentration at which to make up the medication is given in the Australian Injectable Drugs Handbook.  This invaluable resource should be consulted for every injection that requires mixing before administration.

The handbook also contains information as to the compatibility of the medication with other medications and whether it should be mixed with water or can be mixed with saline or other solutions.