E-prescribing for children
Neil A Caldwell, Consultant Pharmacist, Children’s Services, WUTH
Honorary Lecturer, LJMU
June 2013
What’s different?
Different• Prescription commonly has many iterations.• Initial guesstimate informed, influenced and
modified by multiple individuals over time course: formulation, concentration, volume, brand (taste/palatability), availability or administration time.
• What is margin for variance? What is legal?
Different• Clear, unambiguous order but.....you see
what you assume prescription should be.
• 10kg child prescribed: Clarithromycin (125mg/5mL) liquid, give 62.5g po bd.
• 4 doses charted + checked as given.
DifferentCDS such as advanced dosing model logic.
Criterion Definition
Indication Condition that makes particular dose advisable
Care area Physical location of patient, used to infer intensity
Chronological age Age in years, months, days since birth
Post-conceptional age Age in years, months, days since clinician estimated conception
Dosing weight User defined, may not reflect actual weight
Renal impairment Qualitative assessment by ordering provider: impaired or not impaired
BMC Med Inform Decis Mak 2011; 11: 14
Different• Dose rounding: how, when, who, where?
• Do you round up or down? Influenced by pharmacology, concentration, dose and volume.
• Are “rules” different for different medicines or indications?
Different• Fewer medicines: 4 medicines comprise
>50% of scripts in DGH for children. 150 medicines are 98.5% of prescriptions.
• Adult surgeons often prescribe for children!
• Off label use of medicines, evidence lacking, risk of significant overdose.
What’s not different• Same goal. To create an inpatient or discharge prescription.• Drug catalogue: same products for children and adults, dm+d
description. • Patient PAS system: admissions, transfers, patient identification. • Prescribing style: drug, dose, route, frequency. • Basics of documenting administration, same but differences in times
and double signing.• Basic decision support: allergy checking and interactions. Worries
about alert fatigue.
Personal opinion...• Target children first in system design.• If works for children, will work for adults, but not
vice versa.• Perfect system is pipe dream. Should never
replace practical common sense.• Wherever possible, design out common
“mistakes.”
An observation..“Evolution of EP mirrors child development. After
long and protracted birth EP arrived, and initially throve. During infancy it suffered minor setbacks and a serious scare. It’s now come through these tribulations intact if a little chastened. As EP leaves the toddler years behind it faces a challenging world knowing that with support and guidance it can look forward to childhood with optimism.” Arch Dis Child 2012;97:124–128
E-prescribing must cover your Rsright patient
right medication
right dose
right volume
right route
right time
right documentation