Development and implementation of a paediatric dosing calculator integrated in the Dutch Paediatric Formulary

Abstract

Calculation errors are the most common dosing errors in paediatrics. While health information technology has been advocated to improve patient safety, the broad implementation of computer-calculated dosing in the paediatric setting is delayed for the lack of computable, explicit and unambiguous paediatric dosing guidelines. The structured digital dosing guidelines of the Dutch Paediatric Formulary permitted the development of a paediatric dosing calculator that combines drug dosing recommendations of the formulary with patient variables. We took into account the European Union Medical Devices Directive (EEC 93/43) and international standards describing the requirements for the development and maintenance of medical software, the risk management in relation to medical devices and the application of usability engineering to medical devices. As key steps in the development and risk management of software, we first specified the intended use and primary operating functions, then identified potential failures and resolved failures by corrective measures. The paediatric dosing calculator calculates an individual dose based on specified patient characteristics and the dose recommendations provided in the formulary. This is a step-by-step process where a user first enters patient variables (date of birth, weight) and then selects drug variables (indication, route of administration). Based on the selected patient and drug variables, an individual dose is calculated. In addition, the calculated dose in weight units (grams, milligrams) can be converted to a volume-based dose (millilitres) of a fluid product. We successfully developed and implemented a dosing calculator in our national web-based Dutch Paediatric Formulary, which so far has been used more than 65,000 times monthly.Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s4026 7-020-00724 -y) contains supplementary material, which is available to authorized users.* Tjitske M. van der Zanden

Not yet 90-90-90: A quality improvement approach to human immunodeficiency virus viral suppression in paediatric patients in the rural Eastern Cape, South Africa

“…Although this remains alarmingly high, it is in keeping with findings from a study in a similar rural setting 30 and could be an indication of the complexity of paediatric prescribing. 31 Underdosing significantly improved from 11.7% to 6.4%, whilst the number of daily dosing prescriptions for ABC/3TC combination more than doubled from 18.1% to 44.2%. Viral load monitoring and response to VLs improved, with 16% more patients having their VLs performed within schedule, and the average delay between repeating a VL testing after an initial high VL down from 9.2 to 5.3 months, which is still longer than the 2 months recommended by the national guidelines.…”

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

“…To the best of our knowledge, there are only few published CDS tools for paediatric dosing available that are either certified and/or include a broad variety of active ingredients or products [ 6 ]. Thus, we want to highlight the website Kinderformularium.nl , which is based on the Dutch Paediatric Formulary [ 43 ]. Their comprehensive database provides high-quality information on more than 750 drugs [ 43 ].…”

“…Thus, we want to highlight the website Kinderformularium.nl , which is based on the Dutch Paediatric Formulary [ 43 ]. Their comprehensive database provides high-quality information on more than 750 drugs [ 43 ]. Additionally, van der Zanden et al evaluated the impact of their tool in a simulation study showing that the use of their dosing calculator led to a 15% reduction of overall calculation errors [ 44 ].…”

Does a Dose Calculator as an Add-On to a Web-Based Paediatric Formulary Reduce Calculation Errors in Paediatric Dosing? A Non-Randomized Controlled Study

“…The availability of digitized paediatric dosing guidelines of the Dutch Paediatric Formulary [12] provided the opportunity to develop a website-integrated dose calculator that combines dosing recommendations of the formulary with patient variables. A manuscript describing the development of the calculator has been accepted for publication [13]. In a simulated setting, we tested the ability of the calculator to reduce calculation errors.…”