title: Evaluation of medication dose alerts in pediatric inpatients.
abstract: OBJECTIVE
  This study evaluates the impact of 12,093 consecutive dose alerts generated by a computerized provider order entry system on pediatric medication ordering.
  
  
  METHODS
  All medication orders entered and all resulting medication dose alerts at the Johns Hopkins Children's Medical and Surgical Center in 2010, were retrospectively evaluated. Inclusion criteria were hospitalized patients less than 21 years old. There were no exclusion criteria.
  
  
  RESULTS
  During 2010, there were 7738 admissions for 5553 unique patients. A total of 182,308 medication orders for 1092 unique medications were submitted by providers. Six percent (11,155) of orders or order attempts generated alerts for 2046 patients and 524 medications. Two categories of alerts were analyzed: dose range alerts and informational alerts. 73.4% (8187) of all alerts were dose range alerts, with a compliance rate of 8.5% (694); 26.6% (2968) were informational alerts, with a compliance rate of 5.5% (163).
  
  
  CONCLUSIONS
  We found that underdosing alerts provide less value to providers than overdosing alerts. However, the low compliance with the alerts should trigger the evaluation of clinical practice behavior and the existing alert thresholds. Informational alerts noting the absence of established dosing guidelines had little effect on provider behavior and should be avoided when building a dose range alert system.
authors: Peter L. Reichertz Institute for Medical Informatics University of Braunschweig, Institute of Technology and Hannover Medical School, Germany. corinna.scharnweber@plri.de
authors: Corinna
authors: C
authors: Scharnweber
authors: Brandyn D
authors: BD
authors: Lau
authors: Nicole
authors: N
authors: Mollenkopf
authors: David R
authors: DR
authors: Thiemann
authors: Michael A
authors: MA
authors: Veltri
authors: Christoph U
authors: CU
authors: Lehmann
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D054796:Drug Dosage Calculations; D004360:Drug Therapy, Computer-Assisted / Q000592:standards / Q000639:trends*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards / Q000639:trends*; D008508:Medication Errors / Q000517:prevention & control*; D017010:Reminder Systems / Q000592:standards*; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: ADEs; CPOE; Computer software; Drug safety; JHCMSC; Johns Hopkins Children's Medical and Surgical Center; Medication errors; NDR; No24h; Provider order entry; Provider participation; adverse drug events; computerized provider order entry; no 24hour; no dose range available