title: Automated dose-rounding recommendations for pediatric medications.
abstract: BACKGROUND
  Although pediatric electronic prescribing systems are increasingly being used in pediatric care, many of these systems lack the clinical decision-support infrastructure needed to calculate a safe and effective rounded medication dose. This infrastructure is required to facilitate tailoring of established dosing guidance while maintaining the medication's therapeutic intent.
  
  
  OBJECTIVE
  The goal of this project was to establish best practices for generating an appropriate medication dose and to create an interoperable rounding knowledge base combining best practices and dose-rounding information.
  
  
  METHODS
  We interviewed 19 pediatric health care and pediatric pharmacy experts and conducted a literature review. After using these data to construct initial rounding tolerances, we used a Delphi process to achieve consensus about the rounding tolerance for each commonly prescribed medication.
  
  
  RESULTS
  Three categories for medication-rounding philosophy emerged from our literature review: (1) medications for which rounding is used judiciously to retain the intended effect; (2) medications that are rounded with attention to potential unintended effects; and (3) medications that are rarely rounded because of the potential for toxicity. We assigned a small subset of medications to a fourth category-inadequate data-for which there was insufficient information to provide rounding recommendations. For all 102 medications, we were able to arrive at a consensus recommendation for rounding a given calculated dose.
  
  
  CONCLUSIONS
  Results of this study provide the pediatric information technology community with a primary set of recommended rounding tolerances for commonly prescribed drugs. The interoperable knowledge base developed here can be integrated with existing and developing electronic prescribing systems, potentially improving prescribing safety and reducing cognitive workload.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN 37232, USA. kevin.johnson@vanderbilt.edu
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Johnson
authors.forename: Carlton K K
authors.initials: CK
authors.lastname: Lee
authors.forename: S Andrew
authors.initials: SA
authors.lastname: Spooner
authors.forename: Coda L
authors.initials: CL
authors.lastname: Davison
authors.forename: Jill S
authors.initials: JS
authors.lastname: Helmke
authors.forename: Stuart T
authors.initials: ST
authors.lastname: Weinberg
mesh_terms: D002648:Child; D004305:Dose-Response Relationship, Drug; D004360:Drug Therapy, Computer-Assisted / Q000379:methods / Q000592:standards*; D064420:Drug-Related Side Effects and Adverse Reactions; D055695:Electronic Prescribing / Q000592:standards*; D019538:Health Care Surveys / Q000379:methods / Q000592:standards; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards*; D008508:Medication Errors / Q000517:prevention & control; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*
chemical_list: D004364:Pharmaceutical Preparations