To what extent do pediatricians accept computer-based dosing suggestions?

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Medications errors among pediatric inpatients are a noted serious problem. Most common error in this patient population due to dosing error at ordering stage. Most common reason is that pediatric dosing on a per kg basis. Authors attempted to determine: 1) the rates of agreement with suggestions for dose and frequency with decision support; 2) magnitude of disagreement between clinicians and decision support.


Single center retrospective review of CPOE where CPOE decision support rules developed for 200 most commonly ordered medications in a pediatric setting. Acceptance defined as orders matchd=ed both CPOE-generated dose and frequency suggestions exactly


Among the 27,313 orders placed with suggestions, 8822 (32%) were accepted exactly for dose and frequency. Weight of patient available for only 31% OF 54,413 orders.


Physicians accepted CPOE decison support less one third of the time. Computer did not suggest decison support rules when weight was missing; 31% of orders. Medications that were recently added to formulary were noted to be without decision support. They conclude that comercially available CDS do not provide appropriate rules development; probably because of small market size of patient population.


The authors did not survey the physician users of the CDS for CPOE for perceived value. They also did not determine if variation from CDS suggestions was appropriate. Future studies need to determine if CDS for CPOE in th Pediatric population has an impact on medication errors.