Patient Characteristic dosing support

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Patient Characteristic dosing support

Growth Parameters

Most commonly this will come in the form of weight-based dosing, an essential CDS tool for the pediatric population in particular, but other growth parameters such as height or calculated parameters such as body surface area (BSA) are of value for all treatment populations. Support can come in a variety of forms with varying amounts of automation, but at a minimum the CPOE system should have the patients most recent parameters available and incorporate it into a dosing calculator. Important safety measures include displaying the date the relevant parameters were recorded and allowing the user to use other recorded values or provide an order-specific parameter. More advanced options include the use of order completers such as shortcuts or choice lists to further streamline the parameter-based medication ordering process. They can also be combined with other variables such as indication in more complex creators that can further ensure that the appropriate dose is ordered for the patient. Regardless of the level of complexity, concurrent maximum-dose alerts should also be strongly considered to prevent overdosing that may occur when using these calculators for patients who approach adult-size.

Physiologic Status

The most common changes in physiologic status to consider are changes in renal function, liver function and fluid status. Dosing recommendations for these changes are not always straightforward and may involve consultation with a clinical pharmacist, therefore they do not easily lend themselves to dosing adjustments via order completers. More appropriate decision support may be through relevant data presentation of recent laboratory results or weight changes. Laboratory results could include indicators of organ system function (renal, hepatic, hematologic) or previous serum drug levels, while recent weight changes would be an appropriate indication of fluid status. Additionally one could consider documented problem-triggered ordering guidance or less preferably reactive alerts after the medication is ordered. To maximize the benefit of this data presentation care must be taken to avoid trying to be too comprehensive and limit the information to that which will be most useful, otherwise the information could easily become background noise that will not get the appropriate attention of the ordering clinician.


Kuperman et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc (2007) vol. 14 (1) pp. 29-40

H. Carter. Electronic health records: a guide for clinicians and administrators. (2008) pp. 530

Submitted by Eric Shelov