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| 1. |
A) What if a child’s weight color is different from his length color?
B) Your ER system is a length based system. What do we do if we weigh a child and get a different color?
C) Can we access system information based on length AND weight?
That’s OK. It will happen when dealing with children who have obesity, special needs, or are dramatically underweight for their size. A child’s length color is best when dealing with emergency situations. For emergency equipment, weight does not play a significant role (i.e. endo-tracheal tube length not adjusted for weight).
Also, most emergency resuscitation meds are absorbed into lean body mass, therefore dosing is calculated based upon ideal body weight.
A physician can determine whether or not to bump an overweight child up a color for the purpose of medication dosing.
For medical purposes (in a hospital/ER), weight is best for dosing. But in an emergency, weight will provide adequate information without the possibility of overdosing.
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| 2. |
What if our docs want to use the “old” way of dose calculation? Can we (nurses) still use the drug reference guides?
Yes. The drug reference guide not only provides an alternate way to order medications, it also provides a way to double check doses that you are given by a doctor if he prefers to use mathematical calculation to decide a dose. He may not give the exact amount that we list in our book, but you will be able to tell if his order is a reasonable dose and pick up any ten-fold errors.
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| 3. |
How do we “customize” color coding to other departments within our hospital?
There are many ways to customize our system. Depending on your license, you can transport information throughout your facility using information from your materials. You may want to print off and laminate a set of color-specific flow charts from your point of care manuals for Anaphylaxis, and place them in your x-ray department. You could place our flow charts for Procedural Sedation in the same format in your O.R., or in orthopedics. Our website will have many of the customization suggestions available for you to view and use within your facility.
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| 4. |
Can we send orders to the pharmacy such as “Midazolam IV pink” or will we need to write out the entire order as we do now?
That will depend on how your hospital policies reflect the implementation of color coding patients and pediatric medicine. We certainly provide all of the information necessary for a complete doctor’s order within our key words, but it is necessary for your physician to use the key words when ordering the medication. To use your example, the pink dose for the order you specified is 0.3mg/kg and the dosage formula is 0.05mg/kg. There are other indications for Midazolam. One of those is Midazolam induction IV. Here, the pink dose is 2mg. This dose is based on 0.3mg/kg dosage formula that your physician would have to be specific with the use of our key words. Initially, writing it out is a way to make sure that the dose you receive from pharmacy is what your doctor ordered. (Double-checking) When the pharmacy becomes accustomed to receiving orders in this format, and the physicians get used to using the key words when ordering medications, transcription of orders in the manner you suggested will be the natural flow of communication.
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| 5. |
If a patient is brought in by EMS and has been measured by the Broselow Tape and found to be one color, and then later on during his admission, weighed and found to be another color due to weight issues, do we re-code him?
Yes. You should use weight whenever you have it. Length is best in emergencies when a weight is not available and is adequate for medical treatment, but weight is best for medical treatment. When in doubt, always use length. Once an accurate weight is obtained, change the primary I.D. color of the patient to correspond with the weight.
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| 6. |
Where can we get color-coded discharge information to send home with patients?
Our web site will have a section with “customization options” that will provide a selection of color coded medical and safety tips that can be printed off and sent with patients. An initial set of templates with selected information for discharge will be provided on CDROM. This will be generic information, not patient or situation-specific information. Our goal is to have this type of individualized information available with integrated software packages at a later date.
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| 7. |
How can we order more supplies after we run out of the initial toolkit supplies and can we order individual/single colors of armbands and stickers?
Our web site will have purchasing information listed as well as a product catalog with singe items and different quantities to choose from. Ordering will be done through Vital Signs, Inc.
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| 8. |
What if we don’t want to put another armband on a child that already wears three per hospital policy? Can we leave it off? Can we combine your color coding with our patient information /ID to prevent becoming cumbersome with the bands on a patient’s arm?
We do not recommend leaving it off, as the ID bracelet on the child is part of the visual safety check of medication administration in our system of error reduction. The bracelet provides a last minute, real world check of a dose of medicine before it enters the patient. If the syringe or IV bag of fluids you are going to administer has a red label and the child in the room has an orange armband on, you will see the discrepancy before you administer the medication. Hopefully, by having the ID color available for the child and family members to know will help prevent errors by enabling them to notice that colors don’t match.
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| 9. |
What if your system doesn’t have a medicine that we commonly use?
We are a system for the most commonly used medications in the field of pediatrics. There will always be medicines that are not included in our materials. However, our system is in a constant state of development. New medicines are approved, and other medicines were not selected in our current edition. If you would like to see a medication added to any of our books and reference guides, feel free to contact us with that information through our web site and we will certainly consider your request. Updates will be made available via the web site and when enough information has accumulated that we can send it via CD ROM, those will be available. We also anticipate revised editions of our printed material over the next few years.
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| 10. |
Is this system recognized outside of the hospital? For discharge prescriptions, will we have to use the “old” way of writing them out or will we be able to send the key word format to community pharmacy and other facilities?
It is our long-term goal to have the use of prescriptions in the community in the key word format. This is not yet available in community facilities. We believe that with increased use of our system, the natural evolution of communication will become color coded from the medical facilities to the community.
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| 11. |
How do you alter a dose while still using the standard dosing of your system? What about patients with special medical needs, or emergency situations, where you might want to give more or less than the standard listed amount of a medication?
You can always accomplish this by inserting a modifier when ordering a drug. A physician might want to give more than our listed amount of Morphine to a “yellow” patient. He could easily phrase his order as “twice the yellow dose” and convey to the nurse that he wants two times the standard listed amount of Morphine given to the patient without confusing or changing the primary color. He could also order “half of the red dose” of Morphine and therefore indicate that he wanted to decrease our standard listed dose by one- half.
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| 12. |
Are there any simple steps to follow or rules to remember while getting used to the new way of color- coding patients for medical treatment that will help us to adjust to changing over to this system?
There are 3 rules in our system that should be followed and will serve as a guide for color coding kids for medical treatment. They are an anagram for our initials, C-C-K.
1. Color - always identify the primary color of each patient. Length is best for emergencies and is adequate for medical treatment, but weight is best for medical treatment. When you have an accurate weight, use it. Be sure to match the I.D. color of your patient to any tool you are using for treatment.
2. Concentration - this applies to the mLs-based portion of our Point of Care manuals. When referencing a dose of medication in mLs, be sure to match the concentration formula on the bottle or package of medication you are giving to the concentration formula listed in the tool you are using before administering the medication.
3. Key Words - many drugs in our system have more than one indication and therefore more than one dosing formula for administration. We differentiate between multiple drug indications by the use of key words. These key words are the identifiers of the dosing information embedded within ordering medications using our system. The key words will provide the pharmacy with the specific formulas to prepare medications ordered in this format. They will also alert the nurse to double check the indication of a medication when it is ordered. |
