Hospitals in pursuit of excellence

Events Associated with the Prescribing, Dispensing,and Administering of Medication Loading Doses

A loading dose is an initial dose of medication administered to rapidly achieve therapeutic levels. The determination of a loading dose can be complicated, involving calculations dependent upon patient characteristics. This, combined with the need to also administer maintenance doses, creates complexity and opportunities for errors.

From June 2004 through May 2012, Pennsylvania facilities reported to the Pennsylvania Patient Safety Authority 580 events associated with the prescribing, dispensing, and administering of medication loading doses, 15 of which were harmful events. The most common types of events reported included:

• Loading dose omitted or delayed;
• Wrong loading dose given; and
• Loading dose given multiple times.

The predominant medication associated with these reports was vancomycin (14.8%, n = 86). Phenytoin was the medication most frequently involved in harmful events (26.7%, n = 4). Strategies to prevent errors associated with loading doses include developing standardized clinical guidelines on how to prescribe, administer, and monitor loading and maintenance doses; standardizing electronic and paper order sets and protocols; and including a thorough review of current drug therapy during patient handoffs.