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Kid-sized doses in an adult-sized world

  • Salman Naqvi, MD, MPH
  • 07/21/2015

When prescribing medications, physicians base it on the weight of the patient. Pediatricians are constantly scaling doses to fit their patients, increasing the risk of errors.

To ensure patient safety, Phoenix Children’s Hospital (Phoenix, Arizona, U.S.A.) wanted to find an enhanced solution to Dose Range Checking (DRC) to help its clinicians during order entry. Phoenix Children’s Hospital Chief Medical Information Officer, Dr. Vinay Vaidya, M.D., shared more information in a recent Client Outcomes Collaboration Program webinar. The positive results were also published in an article in the Journal of Patient Safety.

Phoenix Children’s had three goals for this project. First, given the importance of pediatric patient safety, it wanted to move quickly. Second, it wanted to take a phased approach, addressing high-risk, high-frequency medications first. And third, it was striving for zero prescribing errors.

Unfortunately, there weren’t any commercially available, pediatric-specific, plug-and-play DRC applications. But because Phoenix Children’s has Allscripts SunriseTM, which is an Open platform, it could rapidly change its configuration with a medical logic module (MLM).

How a single MLM simplified complex configurations

Phoenix Children’s recognized the complexity of configuring hard and soft limits for hundreds of drugs. The traditional approach is to configure one limit at a time. But Phoenix Children’s took a more efficient approach and created one single DRC reference table and a single MLM.

In just four months, this MLM brought 604 dosing rules to the system – far more than the 75 rules previously available. Those rules will trigger alerts if a physician prescribes a dose that falls outside a standard range. Physicians who receive the alerts have the opportunity to review the order and either change or override it, depending on the best interests of the patient.

The system has been in place for more than three years. It triggers about 30 alerts every day – or 3% of the drug orders at Phoenix Children’s. Of the 330 hard stops each month, 90% resulted in modified orders. Another benefit of the MLM was that it reduced “alert fatigue” when it decreased daily dose range alerts from 20% to 3%.

Allscripts Sunrise clients can find more detail about Phoenix Children’s DRC MLM in a solution guide and webinar presentation. To learn about the next webinar, visit the Client Outcomes Collaboration Program site on ClientConnect.

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About the author

Salman Naqvi, MD, MPH is the Director of Client Value and Outcomes program at Allscripts. He has been with the company for more than 10 years and has led various teams across Clinical Content, Sunrise Consulting and Implementation in Acute, Emergency, Ambulatory care areas in more than 35 hospitals and healthcare systems in the United States, Canada, and Asia Pacific; and managed various Optimization and Outcomes Improvement initiatives. Born and trained as a doctor in Pakistan, Dr. Naqvi served at a Presidential Task Force on Health Sector improvements in Pakistan and has a Masters in Public Health from Harvard T.H Chan School of Public Health.

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