Using a computerized provider order entry system to meet the unique prescribing needs of children: description of an advanced dosing model

Abstract

BackgroundIt is well known that the information requirements necessary to safely treat children with therapeutic medications cannot be met with the same approaches used in adults. Over a 1-year period, Duke University Hospital engaged in the challenging task of enhancing an established computerized provider order entry (CPOE) system to address the unique medication dosing needs of pediatric patients.MethodsAn advanced dosing model (ADM) was designed to interact with our existing CPOE application to provide decision support enabling complex pediatric dose calculations based on chronological age, gestational age, weight, care area in the hospital, indication, and level of renal impairment. Given that weight is a critical component of medication dosing that may change over time, alerting logic was added to guard against erroneous entry or outdated weight information.ResultsPediatric CPOE was deployed in a staggered fashion across 6 care areas over a 14-month period. Safeguards to prevent miskeyed values became important in allowing providers the flexibility to override the ADM logic if desired. Methods to guard against over- and under-dosing were added. The modular nature of our model allows us to easily add new dosing scenarios for specialized populations as the pediatric population and formulary change over time.ConclusionsThe medical needs of pediatric patients vary greatly from those of adults, and the information systems that support those needs require tailored approaches to design and implementation. When a single CPOE system is used for both adults and pediatrics, safeguards such as redirection and suppression must be used to protect children from inappropriate adult medication dosing content. Unlike other pediatric dosing systems, our model provides active dosing assistance and dosing process management, not just static dosing advice.

Interventions to reduce medication errors in neonatal care: a systematic review

“…Electronic medication prescribing and atuomated dose checking [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Computerized physician order entry (n = 5)…”

Medication Order Entry and Clinical Decision Support

“…19 Although information on dosing approved by the FDA prevents ordering an approved dose of a medication outside of a usual dosage range, many drugs do not have approved dosing for commonly encountered situations, such as approved pediatric dosing, or dosing generally accepted as safe and effective, or dosing used in investigational protocols. 20 …”

Clinical Decision Support in the Pediatric Hospital Setting

“…When providers enter a medication order in CPOE, most systems will reference a set of drug dosing rules to validate or refute the prescribed dose based on the context, displaying an alert to the clinician if the dose is out of an acceptable predetermined range. Implementation of pediatric-specific rules can be difficult in settings where the same CPOE system is used for adult care [24,25]. Other common forms of CDS related to CPOE include drug-drug interaction, drug-allergy checking, and immunization ordering support.…”