Recommendations on rounding pediatric doses may improve e-prescribing while reducing risk of adverse drug events
A key problem in designing electronic prescribing (e-prescribing) systems for pediatric patients has been solved, according to a new study. Clinical decision support systems for e-prescribing need to calculate a dose that is both appropriate for a child's age and weight (or body surface area)—yet is safe, effective, and can be prepared readily. The percentage change by which the prescribed dose can be rounded for ease of preparation or administration, while remaining effective and safe, varies from drug to drug. Some medicines given to children have a small range for dosages that are both effective and safe, while other drugs have wider tolerances.
In the course of the study, the researchers drew on expert opinion and the scientific literature to classify 120 medications (comprising more than 95 percent of the most commonly prescribed pediatric medications at two academic medical centers) into three major categories related to dose rounding—plus a small category of medications for which data was inadequate and very little rounding was recommended. The major categories were: (1) medications for which doses could be rounded by 5–10 percent while retaining the intended effect; (2) medications for which dose rounding of 10–15 percent was possible, with a focus on preventing potential dose-dependent adverse effects; and (3) medications that could only be rounded by 1–5 percent because of a high risk for toxicity.
After four rounds of discussion by their expert panel, consensus was reached on 99.3 percent of the medications. The researchers view this process as critical for developing the information needed for e-prescribing dose-rounding calculations. The study was funded in part by the Agency for Healthcare Research and Quality (HS17216).
More details are in "Automated dose-rounding recommendations for pediatric medications," by Kevin B. Johnson, M.D., M.S., Carlton K.K. Lee, Pharm.D., M.P.H., S. Andrew Spooner, M.D., M.S., and others, in the August 2011 Pediatrics 128(2), pp. e422-e428.
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