choice of agent, remain vigilant for changes in patient status, and intervene before a minor issue becomes a serious one The needs of the provider or the institution must not be placed ahead of the safety or comfort of the patient A physician should always prepare, and ensure adequate staffing, for a deeper level of sedation than originally planned Medication Errors There is always a chance for error with medications All ED staff, including physicians, nurses, pharmacists, and support staff, should take steps to prevent medication errors Look-alike and sound-alike drugs, sometimes with similar packaging, are contributing factors in some errors Caution should be used in stocking medications Allergic reactions are potential complications with any medications Preventable errors related to medication allergies may occur when the healthcare provider fails to obtain an adequate medical history, fails to read the record, or does not review previously documented allergies Some of the more serious medication errors involve a misplaced decimal point, which can result in a 10-fold error Dosing errors are the leading category of mishaps involving medications and about 10% of these are related to an incorrect weight (obtained or recorded incorrectly) for the child The patient’s weight must be carefully recorded in an obvious location in the record and it is best to record this consistently in kilograms Studies performed on inpatient units have shown that computerized physician order entry systems, particularly those with automated alerts for high- or lowdosage errors, have reduced medication errors by 55% Institutions are required by The Joint Commission and the Centers for Medicaid and Medicare Services (CMS) to establish a list of “high-alert” drugs that would require special or additional checks in their dosing, preparation, and administration; however, all medications should be double checked before they are administered Research shows that 95% of all mistakes are found when someone checks the work of another Having a satellite pharmacy that serves the ED with unit dosing rather than having nurses prepare medications may be beneficial It is interesting to note that, in the hospital setting, 39% of errors are detected before reaching the patient In the ED setting, only 23% of errors are detected before