Download Intravenous Additives - ePrescribing Toolkit

E-prescribing for children
Neil A Caldwell,
Consultant Pharmacist, Children’s Services, WUTH
Honorary Lecturer, LJMU
June 2013
What’s different?
What’s different?
What’s not?
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.
Different
CDS 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 Rs
right patient
right medication
right dose
right volume
right route
right time
right documentation