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

Abstract

Objectives The structured digital dosing guidelines of the web-based Dutch Paediatric Formulary provided the opportunity to develop an integrated paediatric dose calculator. In a simulated setting, we tested the ability of this calculator to reduce calculation errors. Methods Volunteer healthcare professionals were allocated to one of two groups, manual calculation versus the use of the dose calculator. Professionals in both groups were given access to a web-based questionnaire with 14 patient cases for which doses had to be calculated. The effect of group allocation on the probability of making a calculation error was determined using generalized estimated equations (GEE) logistic regression analysis. The causes of all the erroneous calculations were evaluated. Results Seventy-seven healthcare professionals completed the web-based questionnaire: thirty-seven were allocated to the manual group and 40 to the calculator group. Use of the dose calculator resulted in an estimated mean probability of a calculation error of 24.4% (95% CI 16.3-34.8) versus 39.0% (95% CI 32.4-46.1) with use of manual calculation. The mean difference of probability of calculation error between groups was 14.6% (95% CI 3.1-26.2; p = 0.013). In a secondary analysis where calculation error was defined as a 10% or greater deviation from the correct answer, the corresponding figures were 19.5% (95% CI 13-28.2) versus 26.5% (95% CI 21.6-32.1) with a mean difference of 7% between groups (95% CI 2.2-16.3; p = 0.137). Juxtaposition, typo/transcription errors and non-specified errors were more frequent as cause of error in the calculator group; exceeding the maximum dose and wrong correction for age were more frequent in the manual group. The percentage of tenfold errors was 3.1% in the manual group and 3.7% in the calculator group. Conclusions Our study shows that the use of a dose calculator as an add-on to a web-based paediatric formulary can reduce calculation errors. Furthermore, it shows that technologies may introduce new errors through transcription errors and wrongly selecting parameters from drop-down lists. Therefore, dosing calculators should be developed and used with special attention for selection and transcription errors.

Development and Evaluation of a Web-Based Paediatric Drug Information System for Germany

“…These are, for example, computerised physician order entry (CPOE) and platforms that contribute to prescribing and administration decisions, including written protocols for high alert drugs [ 26 , 28 , 29 ]. Recently, van der Zanden et al showed that a dosage calculator as an add-on to a web-based paediatric formulary has the potential to reduce calculation errors [ 30 ]. The integration of an automated dosage calculator, however, implies registration as a medical device, which necessitates the sustainability of the database and liability of the data deployed in the system.…”

“…Different approaches have been suggested to reduce medication errors, including calculation errors. These are, for example, computerised physician order entry (CPOE) and platforms that contribute to prescribing and administration decisions, including written protocols for high alert drugs [26,28,29]. Recently, van der Zanden et al showed that a dosage calculator as an addon to a web-based paediatric formulary has the potential to reduce calculation errors [30].…”

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].…”

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

“…Calculation errors resulting from the use of a dosing calculator are assumed to be driven by software programming errors. The failures identified during the development and the evaluation of our web-based paediatric dosing calculator in a separate simulation study [30] indicate, however, that a correctly calculated dose for an individual patient is equally dependent on correct data entry, selection of parameters and interpretation of data by the user. Users' skills of interacting with technology need to be taken into account when developing healthcare technology solutions [29].…”