Biomaterial Database

Decision support for sensible dosing in electronic prescribing systems. 2012

J J Coleman, and U Nwulu, and R E Ferner

University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. j.j.coleman@bham.ac.uk

OBJECTIVE The sensible dosing of medicines can ensure that patients receive neither excessive doses leading to toxicity nor inappropriately low doses leading to undertreatment. Computerized prescribing systems with embedded decision support can check doses during prescription order entry and display alerts when the prescribed doses are out of range. We have been unable to identify any scheme for the systematic addition of dosing information to CPOE systems. We used pharmacological data to design an algorithm for dose range checking that we tested on a subset of medicines in an electronic prescribing system to ensure that the rules could be implemented in practice. METHODS We drafted an initial algorithm based on pharmacological principles, tested it on a subset of frequently prescribed drugs in an electronic prescribing system and then refined it. We considered which clinical decision support functions systems would require to be maximally effective. CONCLUSIONS The final algorithm contained eleven broad factors. We tested it on 30 drug-route-form combinations, and it accommodated the information for all of these combinations. We also identified a variety of system functions that would be required for comprehensive dosing decision support. CONCLUSIONS The dose range checking algorithm that we have derived from first principles will allow the clinical workflow and warnings to be constructed more effectively within systems to enhance patient safety. This will form a basis for the development of optimal schemes for adding decision support to prescribing systems.

UI	MeSH Term	Description	Entries
D008508	Medication Errors	Errors in prescribing, dispensing, or administering medication with the result that the patient fails to receive the correct drug or the indicated proper drug dosage.	Drug Use Error,Errors, Medication,High-Alert Drug Error,High-Alert Medication Error,LASA Medication Errors,Look-Alike Drug Name Errors,Look-Alike Sound-Alike Drug Errors,Look-Alike Sound-Alike Drug Substitution Errors,Look-Alike Sound-Alike Medication Errors,Lookalike Drug Name Errors,Lookalike Soundalike Drug Errors,Lookalike Soundalike Drug Substitution Errors,Lookalike Soundalike Medication Errors,Drug Error, High-Alert,Drug Use Errors,Error, Drug Use,Error, LASA Medication,Error, Medication,High Alert Drug Error,High Alert Medication Error,High-Alert Drug Errors,High-Alert Medication Errors,LASA Medication Error,Look Alike Drug Name Errors,Look Alike Sound Alike Drug Errors,Look Alike Sound Alike Drug Substitution Errors,Look Alike Sound Alike Medication Errors,Medication Error,Medication Error, High-Alert,Medication Error, LASA,Medication Errors, High-Alert,Medication Errors, LASA
D004305	Dose-Response Relationship, Drug	The relationship between the dose of an administered drug and the response of the organism to the drug.	Dose Response Relationship, Drug,Dose-Response Relationships, Drug,Drug Dose-Response Relationship,Drug Dose-Response Relationships,Relationship, Drug Dose-Response,Relationships, Drug Dose-Response
D004360	Drug Therapy, Computer-Assisted	Adjunctive computer programs in providing drug treatment to patients.	Computer-Assisted Drug Therapy,Protocol Drug Therapy, Computer-Assisted,Therapy, Computer-Assisted Drug,Computer Assisted Drug Therapy,Computer-Assisted Drug Therapies,Drug Therapies, Computer-Assisted,Drug Therapy, Computer Assisted,Protocol Drug Therapy, Computer Assisted,Therapies, Computer-Assisted Drug,Therapy, Computer Assisted Drug
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000465	Algorithms	A procedure consisting of a sequence of algebraic formulas and/or logical steps to calculate or determine a given task.	Algorithm
D050316	Medical Order Entry Systems	Information systems, usually computer-assisted, that enable providers to initiate medical procedures, prescribe medications, etc. These systems support medical decision-making and error-reduction during patient care.	CPOE,Order Entry Systems, Medical,Alert Systems, Medication,Computerized Physician Order Entry,Computerized Physician Order Entry System,Computerized Provider Order Entry,Computerized Provider Order Entry System,Medication Alert Systems,Alert System, Medication,Medication Alert System,System, Medication Alert
D055553	Prescription Drugs	Drugs that cannot be sold legally without a prescription.	Prescription Drug,Drug, Prescription
D055695	Electronic Prescribing	The use of COMPUTER COMMUNICATION NETWORKS to store and transmit medical PRESCRIPTIONS.	E-Prescribing,E-Prescriptions,Electronic Prescriptions,Electronic Transmission of Prescriptions,E Prescribing,E Prescriptions,E-Prescription,Electronic Prescription,Prescribing, Electronic,Prescription, Electronic,Prescriptions, Electronic
D020000	Decision Support Systems, Clinical	Computer-based information systems used to integrate clinical and patient information and provide support for decision-making in patient care.	Clinical Decision Support System,Clinical Decision Support Systems,Clinical Decision Support,Decision Support, Clinical,Clinical Decision Supports,Decision Supports, Clinical,Support, Clinical Decision,Supports, Clinical Decision