Question
what are the rules and steps in calculating drug dosages?
Answer
Doing the math
Even with the programmable I.V. pumps used in many clinical settings, it's advisable for the nurse to verify the correct dosage by calculation once during the shift; more often if a medication is being titrated or changed. Verification of correct dosages with another RN is also a widespread practice among many professionals and sometimes mandatory in institutions.
Another resource that's present in many practice settings is the pharmacy. Pharmacists have an abundance of knowledge about medications, as well as an unparalleled proficiency with drug calculations; utilize their expertise if you're unsure of your computation.
Knowing the therapeutic dosage for the desired effect is as important as knowing the correct calculations for the drug. For example, dopamine at doses of 3 to 5 mcg/kg/minute provides a gentle dilatation of the renal arteries, increasing urine output with no effect on BP. At higher doses (up to 20 mcg/kg/minute), dopamine is used for BP support. Know the medication and what effect you're attempting to achieve, as well as the maximum recommended safe infusion dosage.
Next time you have a patient on I.V. medication, try the following simple methods for calculating in a systematic way. Patient medication safety is a goal that all practitioners have in common - it starts with doing the math.
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-John
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