Safe Drug Calculations

Clinical Skills
Safe Drug Calculations

Sian Williams (Clinical Skills Manager)

Dr Brian Jenkins (Clinical Skills Lead)
 Safe Drug Calculations
Aims & Outcomes

Aims & Outcomes

The aim of this module is to facilitate student learning regarding the need for, and how to carry
out of Safe Drug Calculations.

The learning outcomes are:

 To describe why performing safe drug calculations is vital for patient safety.
 To summarise the key points for safe prescribing.
 To be able to use simple formulae to carry out drug calculations.
 To apply learned knowledge to work through more complex drug calculations.
 To be able to perform a test within the module to an acceptable standard.
 To be able to consolidate your knowledge in a summative quiz.
 To review your learning, and plan a strategy to meet any deficits in your knowledge.
 Safe Drug Calculations
Introduction

Introduction
The use of medication has many healthcare benefits for patients. However, every year in the UK, 10,000 patients
have serious adverse drug reactions, with one fifth of clinical negligence litigation stemming from hospital
medication errors. The true extent of medication errors in hospitals is unknown.

The National Patient Safety Agency (NPSA) publishes data every year regarding reported incidents occurring
within the UK. In July 2008-June 2009 3,426 medication incidents were reported in Wales. This was a rise of 433
incidents from the previous year. The most common types of medication incidents reported to the NPSA are
wrong dose, strength, frequency, omitted medicine and wrong medicine (NPSA 2007).

Against this background, it is essential that students receive education in prescription writing and drug
calculation, to ensure potential risks and harm to patients are minimised.
 Safe Drug Calculations
Introduction

Introduction
There are many instances when you may have to calculate a drug dose. The drug calculation required may be to:

• Calculate the number of tablets required.

• Calculate the amount of liquid medication required.
• Calculate the number of units required.
• Reconstitute a powder into a liquid and calculate the amount required.
• Calculate the rate in drops per minute for an intravenous infusion.

All drug calculations require a certain degree of mathematical skill. The required level is not high, but it is
essential that you are competent to a certain level to ensure the safety of patients is not compromised. If you
require some support in your Mathematical skills, there is no shame in this. Please go to the University Maths
support page indicated below.

Please go to the University Maths support page indicated in the 'Tips for Safe Practice' page at the end of this
module.
 Safe Drug Calculations
Introduction

Introduction
Remember:
• Prescribe generically whenever possible
• Prescribe legibly (BLOCK CAPITALS) in ink and rewrite errors
• Don’t use unnecessary decimal points or terminal zeros
• Use g, mg, micrograms or nanograms
• Use ml or mL, not cc or cm3
• For “as required” medicines, state minimum dose interval
• Directions should preferably be in English

Key to text-colours used in this module:

• Red – This is the dose that has been prescribed
• Blue – Weight per unit. The concentration of drug per unit volume
• Green – The stock volume
 Safe Drug Calculations
Learning Outcome - Tablet Calculation

Calculating the number of tablets required

A whole tablet is always preferable to a what you want
broken tablet as the latter will have no = number of tablets
predictable dose. It is worth checking what you have (amount
with Pharmacy whether a drug in a of drug in the tablet)
tablet form can be broken successfully to
achieve a required dose. You need to
know the amount of drug in the tablet
than calculate how many tablets are
needed. All that is required is simple
maths.
 Safe Drug Calculations
Learning Outcome - Fluid Dosage Calculation

Calculating the volume of liquid required

what you want,

x stock volume = volume required
weight per unit (what
you have)

When drugs are in a liquid

form, the availability is given in
terms of the concentration of
the solution or suspension. If
we know the quantity of drug
prescribed, and the
concentration of the drug in
solution, we can calculate the
volume of liquid required.
 Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation

Calculating the volume of solution required

Sometimes a liquid drug may be available in different concentrations. This is often the case for
drugs such as some oral suspensions or linctus (syrup). 5ml is often the unit measure used, so
the calculation is then made in the same way as the previous example.
 Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation

Calculating the volume of solution required (nystatin)

More examples of drugs that have different strengths:

what you want,

x stock volume = volume required
weight per unit (what you
have)
 Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation

Calculating the volume of solution required (Heparin)

More examples of drugs that have different strengths:

what you want,

x stock volume = volume required
weight per unit (what you
have)
 Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation

Calculating the volume of solution required (amoxicillin)

Things get a little more interesting when we have to reconstitute a drug from a powder into an
injectable form. (See the module Safe Injections to help with this).
 Safe Drug Calculations
Solution Dosage Calculations - Introduction

Introduction
In the following slides we have created some simple test formulae using the same principles as the previous
examples. This time however, you are given the chance to 'draw up' the syringe. The steps are:

1. Check the part prescription shown

2. Fill in the formula boxes.
3. Draw up the syringe.

Each calculation provides an option to ‘swap’ the elements of the equation around to suit your preference. Click
on the ‘Swap’ button to choose between each.
Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation 1
Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation 2
Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation 3
Safe Drug Calculations
Learning Outcome - Solution Dosage Calculation 4
 Safe Drug Calculations
Learning Outcome - Intravenous infusions

Calculating the rate of an intravenous infusion

The rate of fluid flow down an intravenous infusion line must be regulated. Accurate, low-flow-
rate, small-volume infusions can be controlled by means of a syringe pump, medium-to-high
flow rates can be controlled by a volumetric infusion pump and basic fluid replacement can be
delivered by the age old method of gravity infusion - more commonly known as the ‘drip’. To use
a syringe pump, or volumetric device you will need to have carried out appropriate training.
 Safe Drug Calculations
Learning Outcome - Intravenous infusions

Calculating the rate of an intravenous infusion

Drip factor: This is indicated on the manufacturer's giving set package and is approximately the
number of drops equivalent to 1ml water. Ensure you have the correct disposable giving set for
the patient.

Adult Paediatric/Micro Blood

20 drops per ml 60 drops per ml 15 drops per ml
 Safe Drug Calculations
Learning Outcome - Intravenous infusions

Calculating the rate of an intravenous infusion

The drip rate is calculated by dividing the total volume (in millilitres) prescribed for the patient
by the number of hours required for the delivery. This gives the infusion rate in millilitres per
hour (ml/hr). To make things easier to set the rate we carry out a simple calculation.

The infusion volume is multiplied by the drip factor for the giving set (nominal number of drops
per ml) and divided by the number of minutes (hours x 60).

Therefore: The flow rate for gravity fed devices =

Total volume (ml) Drip factor of the given set

x = drops per minute
Total time (hrs) 60 (minutes in the hour)
 Safe Drug Calculations
Learning Outcome - Intravenous infusions

Calculating the rate of an intravenous infusion

 Safe Drug Calculations
Learning Outcome - Intravenous infusions

Calculating the rate of an intravenous infusion

Example

A patient is prescribed 500ml IV 5% Dextrose to be given over 12 hours. The giving set has a
drip factor of 20 drops per ml. How many drops per minute will you set the rate.
Calculating the infusion rate in drops per minute
The infusion rate (ml/hr) is multiplied by the drip factor for the giving set (nominal number of
drops per ml) to calculate the total number of drops required per hour

NB: It is necessary to round up to the nearest whole number.

 Safe Drug Calculations
Learning Outcome - Intravenous infusions

Calculating the rate of an intravenous infusion

One litre of Dextrose 5% in water to be given over 3 hours. The drip factor is 10. The IV has been
running for 1 hour and 15 minutes. 500 ml remain. How many drops per minute are needed so
that the IV finishes in the required time?

Therefore:

NB: It is necessary to round up to the nearest whole number.

Safe Drug Calculations
Learning Outcome – IV Infusions Calculation 1
Safe Drug Calculations
Learning Outcome – IV Infusions Calculation 2
Safe Drug Calculations
Learning Outcome – IV Infusions Calculation 3
Safe Drug Calculations
Learning Outcome – IV Infusions Calculation 4
Safe Drug Calculations
Learning Outcome – IV Infusions Calculation 5
 Safe Drug Calculations
Other Drugs

Other Drugs
Some solutions such as local anaesthetics that are used in anaesthesia on a daily basis are
expressed as a percentage eg. lidocaine 2% and bupivacaine 0.5%

When using drugs prepared in this way it is necessary to calculate the number of mg in ml of
solution. This is easiest done by multiplying the percentage of the solution by 10:

The maths behind this calculation is as follows:

2% lidocaine x 10 = 20mg/ml

0.5% bupivacaine x 10 = 5mg/ml

A 2% solution means that there is 2g of Lidocaine in 100ml:

2g in 100ml

= 2000mg in 100ml
divided by 100 = 20mg in 1 ml (20mg/ml)
 Safe Drug Calculations
Other Drugs

Other Drugs
If we were going to carry out some suturing, and needed to infiltrate the wound with lidocaine
hydrochloride, we would need to know the maximum dose we could safely use. This
information could be found in the BNF. It may read

‘Infiltration anaesthesia, by injection, according to patient's weight and nature of procedure,

max. 200 mg (or 500 mg if given in solutions containing adrenaline)’

The maximum dose of lidocaine hydrochloride per kg of body weight is 3mg.

In adults: the usual dose should not exceed 200mg.
In children: the usual dose should not exceed 3mg per kg of bodyweight.
Safe Drug Calculations
Learning Outcome – Local Anaesthesia Calculation 1
Safe Drug Calculations
Learning Outcome – Local Anaesthesia Calculation 2
Safe Drug Calculations
End of Module Questions
 Safe Drug Calculations
Learning Outcome - Tips for Safe Practice

Tips for Safe Practice

Remember:

A rough estimate should always be made first for all calculations, particularly if calculators are
being used.

If your Maths is a little rusty, be sure to look up the University Maths Support section.
http://www.cardiff.ac.uk/mathssupport/index.html

If you are in any doubt about a drug or fluid calculation, get someone else to check with you.
 Safe Drug Calculations
References & Links

References & Links

NPSA (2007). Safety in Doses: Improving the use of medicines in the NHS. London, National
Patient Safety Agency.

A site that has an in built calculator for helping with I/V infusion rates, I/V drip rates, and has a
drug dosage calculator.
http://www.medical-calculators.co.uk/dose.htm

A user friendly site that can help with the practise of calculations.
http://www.testandcalc.com/

This module should be used in conjunction with the Safe Prescribing module which is
available through the Clinical Skills section of Learning Central, years 2 to 5.