I gather my notes and call the prescribing pediatrician. This physician is very thoughtful and grateful that I have called him. We get the actual weight, did the calculation and yes; we agreed that the dose, as prescribed, is 3 times the maximum dose. The physician states that he wrote the order exactly as it was on the prescription bottle the mother had received when the child was discharged from the regional hospital. He also states that those neonatal doctors know what they are doing and that the baby had been stabilized on that dose. He says he will take responsibility for the dosing and that early next week he will be discussing the case with the physicians from the regional facility and he will discuss the dosing with them at that time.
Ok, so I clearly understand this pediatrician, I take copious notes; I discuss the follow-up process with my manager, and continue on to compound the medication. After a couple hours, the non-English speaking grandmother comes in to pick up the medication. We have a Spanish translator technician that helps me explain all of the follow-ups to the grandmother, and off she goes.
I then take my lunch and I can’t get it off my mind. It should be just fine, after all, the physician said he is taking full responsibility for the dosing. All through lunch, I am looking for a reference anywhere that describes this particular dosing regimen for this particular patient situation. I cannot find any reference. After lunch, I call the mother of the patient. She is particularly interested in my discussion and more than willing to work with me over the phone to figure this out. She picks up the bottle that had the medication from the hospital and reads all of the information to me. Patients, when reading a prescription bottle, have a tendency to mix up ml and mg; however, she sounded convincing that it was the same as the prescription that we had dispensed.
After another 30 minutes of running this through my head, I called the mother back once again. I asked her for the phone number on the label of the prescription from the other facility. I called the other pharmacy to ask them what they had dispensed and what the directions on the label read. Sure enough, the dose that the local pediatrician had prescribed, we compounded and dispensed was 5 times what the patient had been receiving at the hospital prior to discharge.
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