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Joint Commission and use of the Broselow tape

From the March 24, 2005

The Broselow tape, which uses color-coding to approximate a weight based on the child's length, is widely used during pediatric emergencies to quickly estimate drug doses and the correct size of resuscitation equipment. While we've occasionally described medication errors that have surfaced with the use of the tape, it's clear that the tape still helps prevent errors by simplifying drug dosing and choice of medical equipment, especially in emergency departments where children are treated infrequently.

Lately, we've heard that Joint Commission surveyors have inadvertently or actively discouraged use of the Broselow tape because, similar to the Rule of 6, varied concentrations of drug infusions are used, thus not meeting their requirement for standardized concentrations of drug infusions. Unfortunately, in some cases, hospitals have interpreted this to mean that the tape should be removed from crash carts and not used. We do not recommend this. In our February 24, 2005 newsletter, we agreed that use of standardized concentrations reduces the risk of calculation and preparation errors. We also recommended labeling the infusion portion of the tape to direct people to titration tables using standard concentrations. However, this admittedly is not a long-term solution, but a temporary measure until infusions have been removed from the Broselow tape, as promised with future revisions. We've suggested to the Joint Commission that it would be safest to allow hospitals a sufficient period of time for transitioning to standard concentrations during pediatric emergencies, as was granted to hospitals that had been using the Rule of 6 to prepare pediatric infusions. They have promised to consider the matter.

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