Decision support for sensible dosing in electronic prescribing systems.
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.
University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. j.j.coleman@bham.ac.uk
J J
JJ
Coleman
U
U
Nwulu
R E
RE
Ferner
D000465:Algorithms; D020000:Decision Support Systems, Clinical; D004305:Dose-Response Relationship, Drug; D004360:Drug Therapy, Computer-Assisted / Q000379:methods*; D055695:Electronic Prescribing / Q000592:standards*; D006801:Humans; D050316:Medical Order Entry Systems / Q000592:standards*; D008508:Medication Errors / Q000517:prevention & control; D055553:Prescription Drugs / Q000008:administration & dosage / Q000009:adverse effects
D055553:Prescription Drugs