4: Faisal

Faisal is 3 years old. He has been admitted to the children’s ward with a diagnosis of pneumonia. To date, he has received 3 days of intravenous amoxicillin. The prescription has now been changed to oral amoxicillin. You are undertaking the 12.00 drug round and notice that the 08.00 dose has not been signed for.

What do you do now?

  1. Ask Faisal if he has had his medication at 08.00.
  2. Ask Faisal’s mum if he had his antibiotics this morning.
  3. Give a double dose now as it is important to maintain therapeutic drug levels in Faisal’s blood
  4. Ascertain if the dose was given by asking the nurse who undertook the drug round at 08.00.

› Suggested answers

  1. Ask Faisal if he has had his medication at 08.00.

Faisal is too young to be relied on, therefore this is not an option.

  1. Ask Faisal’s mum if he had his antibiotics this morning

The legal responsibility for the correct administration of drugs in this situation lies with the nurse. Therefore the nurse must ascertain unequivocally whether the dose has been given or not. If there is any doubt then the nurse must err on the side of caution.

  1. Give a double dose now as it is important to maintain therapeutic drug levels in Faisal’s blood

If the nurse now administers a double dose the child will receive too much antibiotic at one time. This would constitute a drug error. The child may also have had the dose at 08.00 and therefore lead to even higher blood drug levels.

  1. Ascertain if the dose was given by asking the nurse who undertook the drug round at 08.00.

This answer would be the ideal solution if the nurse is still on duty and can definitely remember. The nurse could then sign the chart. If the nurse is not available or cannot remember, then in order to prevent a drug error the nurse must administer just one dose at 12.00. This leaves the 08.00 dose possibly not administered.