Pediatric Informatics: Computer Applications in Child Health (Health ...

124 A. Matlow and J.M.A. Bohnen
drug based on specific inclusion criteria: if the patient was a candidate, the order
was completed. An override capability was also incorporated. On review, 65% of
patients received the drug through the computerized algorithm and in the rest, by
overrides. There was no significant in-hospital mortality difference between the two
groups. The authors concluded that anticipatory development of guidelines with
a computer based algorithm should be considered for use of an unapproved drug
when recommendations are imminent.
Example of a clinical algorithm (CA)
Issue
Gentamicin is a nephrotoxic drug.
Gentamicin serum levels must be within a therapeutic range.
The dosage should be adjusted if the peak level is >10 mg/L.
Proposed Solution
When a gentamicin level is elevated, the laboratory report has a tag that reads:
“Serum gentamicin level elevated. Gentamicin is nephrotoxic.
Adjust dosage and follow serum gentamicin levels and serum creatinine.
Discontinuation or further dosage adjustment may be required.”
Another tool that provides a framework for standardization of care is the care
map. Care maps, also called critical care plans or clinical pathways, have been
called the “blueprint of nursing management.” 25 They define the care required for
a designated group of patients, including interventions, time frames and expected
outcomes. In their traditional paper form, standardized interventions are displayed
across a daily timeline; outcome targets and the ability for documentation may or
may not be included. Computerization of care maps that consider the complexity
of medical care are under development. 26
9.5 Bundles
The concept of “care bundles” originated in the USA at the Institute for Healthcare
Improvement (IHI) as a means to improve health care outcomes. The IHI’s recent
100,000 Lives Campaign has raised the profile of care bundles, as they were integrated
into many of the campaign’s interventions. 27 In the UK, care bundles were introduced
as part of a national initiative to modernize critical care following the 1999 publication
of the Department of Health’s review, Comprehensive Critical Care. 28 Evidence to date
suggests that they enhance the ability of CPGs to deliver safe and quality care.