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

BMC Medical Informatics and Decision Making

Technical Advance

Monica M Horvath¹  Asif Ahmad¹  Tres Brown¹  Jeanette Jansen¹  Patricia Schellenberger¹  Jeffrey M Ferranti²  Christopher M DeRienzo³ 

[1] Duke Health Technology Solutions, Duke University Health System, Durham, NC, USA;Duke Health Technology Solutions, Duke University Health System, Durham, NC, USA;Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA;Duke University Hospital, Durham, NC, USA;Duke University Hospital, Durham, NC, USA;

关键词: Pediatric Intensive Care Unit;    Clinical Decision Support;    Dose Region;    Care Area;    Pediatric Dose;   

DOI  :  10.1186/1472-6947-11-14

 received in 2010-04-23, accepted in 2011-02-21,  发布年份 2011

来源: Springer

【 摘 要 】

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component of medication dosing that may change over time, alerting logic was added to guard against erroneous entry or outdated weight information.ResultsPediatric CPOE was deployed in a staggered fashion across 6 care areas over a 14-month period.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.

【 授权许可】

CC BY   
© Ferranti et al; licensee BioMed Central Ltd. 2011