Description of a clinical decision support tool with integrated dose calculator for paediatrics

Higi, Lukas; Käser, Karin; Wälti, Monika; Grotzer, Michael A.; Vonbach, Priska

doi:10.1007/s00431-021-04261-2

Cited by 10 publications

(10 citation statements)

References 30 publications

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“…However, many of these apps are marginally medically correct, have not been validated in evidence-based studies, and have limited usability [ 77 ]. Of the few available medical mobile apps that offer weight-based drug dosing, such as Handtevy Mobile [ 78 ], SafeDose Mobile (eBroselow) [ 79 ], Infinite Dose PRO [ 80 ], Pedi QuikCalc [ 81 ], PEDeDose [ 82 ], and EZDrips Peds [ 83 ], none have shown proven results of their efficacy, especially in terms of usability.…”

Section: Discussionmentioning

confidence: 99%

Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials

Siebert¹,

Gosetto²,

Sauvage³

et al. 2022

JMIR Hum Factors

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Background Mobile apps are increasingly being used in various domains of medicine. Few are evidence-based, and their benefits can only be achieved if end users intend to adopt and use them. To date, only a small fraction of mobile apps have published data on their field usability and end user acceptance results, especially in emergency medicine. Objective This study aims to determine the usability and acceptance of an evidence-based mobile app while safely preparing emergency drugs at the point of care during pediatric in- and out-of-hospital cardiopulmonary resuscitations by frontline caregivers. Methods In 2 multicenter randomized controlled parent trials conducted at 6 pediatric emergency departments from March 1 to December 31, 2017, and 14 emergency medical services from September 3, 2019, to January 21, 2020, the usability and technology acceptance of the PedAMINES (Pediatric Accurate Medication in Emergency Situations) app were evaluated among skilled pediatric emergency nurses and advanced paramedics when preparing continuous infusions of vasoactive drugs and direct intravenous emergency drugs at pediatric dosages during standardized, simulation-based, pediatric in- and out-of-hospital cardiac arrest scenarios, respectively. Usability was measured using the 10-item System Usability Scale. A 26-item technology acceptance self-administered survey (5-point Likert-type scales), adapted from the Unified Theory of Acceptance and Use of Technology model, was used to measure app acceptance and intention to use. Results All 100% (128/128) of nurses (crossover trial) and 49.3% (74/150) of paramedics (parallel trial) were assigned to the mobile app. Mean total scores on the System Usability Scale were excellent and reached 89.5 (SD 8.8; 95% CI 88.0-91.1) for nurses and 89.7 (SD 8.7; 95% CI 87.7-91.7) for paramedics. Acceptance of the technology was very good and rated on average >4.5/5 for 5 of the 8 independent constructs evaluated. Only the image construct scored between 3.2 and 3.5 by both participant populations. Conclusions The results provide evidence that dedicated mobile apps can be easy to use and highly accepted at the point of care during in- and out-of-hospital cardiopulmonary resuscitations by frontline emergency caregivers. These findings can contribute to the implementation and valorization of studies aimed at evaluating the usability and acceptance of mobile apps in the field by caregivers, even in critical situations. Trial Registration ClinicalTrials.gov NCT03021122; https://clinicaltrials.gov/ct2/show/NCT03021122. ClinicalTrials.gov NCT03921346; https://clinicaltrials.gov/ct2/show/NCT03921346 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-019-3726-4

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Section: Discussionmentioning

confidence: 99%

Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials

Siebert¹,

Gosetto²,

Sauvage³

et al. 2022

JMIR Hum Factors

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“…They were requested to follow the dosing guidelines provided as web application CDS by PEDeDose (PEDeus Ltd.), which was described by Higi et al [17]. These dosing recommendations are based on the national harmonized dosing guidelines by Swisspeddose [18] and contain additional information.…”

Section: Information On Drug Dosingmentioning

confidence: 99%

Prescribing errors in children: What is the impact of a computerized physician order entry?

Satir

Pfiffner

Meier

et al. 2022

Preprint

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Purpose: Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children’s Hospital Zurich. Methods: We performed medication review on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index) as well as the interrater reliability (Cohen’s Kappa) were analyzed. Results: CPOE significantly reduced the rate of errors from 25 errors / 100 prescriptions (95% CI: 23 – 27) to 16 errors / 100 prescriptions (95% CI 14 – 18). Particularly the prescribing quality was improved by reducing PCNE error 5.2 “lacking information” (e.g. lacking drug form or maximum possible number of doses for reserve medication). Medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not statistically significantly altered after introduction of the CPOE. Overall severity of errors was reduced. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusions: The CPOE increases patient safety by reducing the rate and severity of prescribing errors. The reason for the observed increase in medication reconciliation problems might be the hybrid-system with remaining paper-prescriptions for special medication. The lacking effect on dosing errors might be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions on how to increase the usability of the CPOE, and full integration of CDS tools such as automated dose check into the CPOE.

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“…PEDeDose is a CDSS to facilitate drug dosing in paediatrics. 13 14 It provides healthcare professionals (HCPs) with structured dosing information and a built-in dose calculator. The CDSS was developed to prevent dosing errors by either supporting prescribers directly or to validate already prescribed dosages.…”

Section: Introductionmentioning

confidence: 99%

“…PEDeDose is a CDSS to facilitate drug dosing in paediatrics 13 14. It provides healthcare professionals (HCPs) with structured dosing information and a built-in dose calculator.…”

Section: Introductionmentioning

confidence: 99%

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Impact of a clinical decision support system on paediatric drug dose prescribing: a randomised within-subject simulation trial

Higi

Schmitt

Käser³

et al. 2023

bmjpo

Self Cite

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BackgroundDrug dosing errors are among the most frequent causes of preventable harm in paediatrics. Due to the complexity of paediatric pharmacotherapy and the working conditions in healthcare, it is not surprising that human factor is a well-described source of error. Thus, a clinical decision support system (CDSS) that supports healthcare professionals (HCP) during the dose prescribing step provides a promising strategy for error prevention.MethodsThe aim of the trial was to simulate the dose derivation step during the prescribing process. HCPs were asked to derive dosages for 18 hypothetical patient cases. We compared the CDSS PEDeDose, which provides a built-in dose calculator to the Summary of Product Characteristics (SmPC) used together with a pocket calculator in a randomised within-subject trial. We assessed the number of dose calculation errors and the time needed for calculation. Additionally, the effect of PEDeDose without using the built-in calculator but with a pocket calculator instead was assessed.ResultsA total of 52 HCPs participated in the trial. The OR for an erroneous dosage using the CDSS as compared with the SmPC with pocket calculator was 0.08 (95% CI 0.02 to 0.36, p<0.001). Thus, the odds of an error were 12 times higher while using the SmPC. Furthermore, there was a 45% (95% CI 39% to 51%, p<0.001) time reduction when the dosage was derived using the CDSS. The exploratory analysis revealed that using only PEDeDose but without the built-in calculator did not substantially reduce errors.ConclusionOur results provide robust evidence that the use of the CDSS is safer and more efficient than manual dose derivation in paediatrics. Interestingly, only consulting a dosing database was not sufficient to substantially reduce errors. We are confident the CDSS PEDeDose ensures a higher safety and speeds up the prescribing process in practice.

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Description of a clinical decision support tool with integrated dose calculator for paediatrics

Cited by 10 publications

References 30 publications

Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials

Usability Testing and Technology Acceptance of an mHealth App at the Point of Care During Simulated Pediatric In- and Out-of-Hospital Cardiopulmonary Resuscitations: Study Nested Within 2 Multicenter Randomized Controlled Trials

Prescribing errors in children: What is the impact of a computerized physician order entry?

Impact of a clinical decision support system on paediatric drug dose prescribing: a randomised within-subject simulation trial

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