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

334 G.R. Kim and R.E. Miller
dispensing, pharmacy information systems (PharmIS, Chapter 27) can reduce
errors in intravenous solution admixtures and in administering drugs. Additionally,
a number of technologies, including bar-coding, radio-frequency identification (and
computer-interfaced supply cabinets), “smart” infusion pumps (Chapter 28) have
been explored to improve delivery and safety of medication use.
25.4 Pediatric Specific Issues in Medication Use
The combination of the increased vulnerability of children and infants to medication
errors and the specific data needs of pediatric care (Chapters 3–8) suggest that pediatric
medication use may benefit from the application of information technology.
Special areas of current interest include:
Pediatric drug dosing: Current systems designed for multispecialty use do not
uniformly or adequately handle universal weight-dose calculations that are common
and vital in pediatrics, including drug dictionaries that reflect age-based
dosages and contraindications, clinical decision support rules that handle age and
weight-based alerts and reminders and integrate the use of growth charts.
Workflow and human computer interface issues: Pediatric-specific medication
workflows include: automatic point-of-ordering weight-based drug dose calculation
(with special consideration of the management of low volume doses), incorporation of
child growth and development data into documentation and decision support, and
just-in-time availability of orders and drugs in emergent situations to optimize care.
Pediatric specialty domains: Children at higher risk for the impact of errors (such
as neonates, children with special health care needs (who may be on many medications,
with many consultants, and children with cancer) may have more complex
care (intensive care, continuous infusions, chemotherapy) that require even more
specialized consideration.
Connection to primary care: Pediatrics is a primary care specialty with an emphasis
on the medical home concept (especially for children with special health care
needs), for which information technology is needed that empowers continuity in
terms of medication use and other aspects of pediatric care.
References
1. Agency for Healthcare Research and Quality. Reducing and Preventing Adverse Drug Events
to Decrease Hospital Costs. Research in Action, Issue 1. AHRQ Publication Number 01-0020,
Rockville, MD; 2001. Available at: http://www.ahrq.gov/qual/aderia/aderia.htm. Accessed
December 21, 2008.
2. Nordenberg T. Pharmacy Compounding: Customizing Prescription Drugs. FDA Consumer
Magazine; 2000. Available at: http://www.fda.gov/Fdac/features/2000/400_compound.html.
Accessed December 21, 2008.
3. United States Pharmacopeia. The Medication Use Process; 2004. Available at: http://www.usp.
org/pdf/EN/patientSafety/medicationUseProcess.pdf. Accessed December 21, 2008.