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

19 Ambulatory Computerized Provider Order Entry 273
weight-based dosing information for drugs, and automated dose calculation.
Additional information (to assure safety) may include: indications for therapy,
dosing intention (formula used in prescribing), and contact information for the provider
and patient in case of a need to discuss the prescription. Table 19.1 lists other
“best practices” for prescription writing (with or without eRx).
Advocacy for pediatric needs in technology development: Not all products support
pediatric-specific data fields or functions (such as weight-based dosing and
checks), and advocacy for their inclusion in settings where children and adults
receive care may be required. Support for some functions is more important in
pediatrics than for adult medicine, such as immunization management 26 (which has
become progressively complex as the number, variations, and frequency of updates
on immunizations and the need to ration doses during shortages increase).
Certification of products and return on investment: Data about pediatric adoption
of eRx are lacking. A recent study showed only 21% of the respondents had an
electronic record in their practice. 37 While this study did not directly address eRx,
only a subset of electronic health record (EHR) systems supports this functionality.
Pediatric practices want assurances that they will have return on their investments
in eRx and that the products they use will adhere to federal and local regulations.
To this end, programs are in the process of developing consensus and evidence
based criteria for certifying HIT products (including ACPOE) for use in different
environments (such as pediatric ambulatory settings).
19.5.2 Pediatricians’ Roles
The pediatrician’s primary roles in ACPOE adoption are as child advocates and
clinical technology user. Clinical and informatics expertise and/or experience,
while essential, are not sufficient to fulfill these roles. Pediatric champions must
Table 19.1 Safe prescribing practices 36
All orders must be legible
Avoid prescribing units such as teaspoons or dropperfuls
Include patient weight and age
Include dosing formula on prescription
Make sure patient’s name and medical record number are on the order sheet
Include the date, time, physician signature, and physician pager number on all orders
When possible, include the purpose of the order (e.g., for cough)
All orders should be written in the metric system, except for therapies that use standard units
(e.g., insulin, vitamins)
Spell out “units” rather than using “U”
Orders should be written in total dosage amount, rather than by volume or as a amount per
weight (e.g., mg/kg)
All medications should always include drug name, exact metric dose and concentration, and
dosage form
A leading zero should always precede a decimal expression of less than one (e.g., 0.1 mg)
Trailing zeros should never be used (e.g., 1.0 vs. 10 mg)