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

26 Prescribing/Ordering: Computerized Order Entry and Decision Support 337
26.3 CPOE/CDS Functions
In inpatient settings, CPOE and associated CDS provide prescribing support to a
clinician (physician, nurse practitioner, nurse, physician assistant) who is authorized
to order medications, laboratory and radiology tests, and treatments, for patients:
The authorized clinician establishes a therapeutic relationship with a patient and
collects data (history, physical examination, laboratory test results) to determine
a diagnosis or problem list for the patient.
Based on the diagnosis or problem list inferred from the collected data, the
clinician determines the need for further testing or specific therapies for
the patient, according to medical evidence, practice guidelines and clinical constraints
(formulary availability, drug interactions).
The clinician formulates, orders, and documents tests and therapies (using CPOE)
that are transmitted to ancillary departments or the pharmacist and nurse for completion.
CDS guides the clinician by guiding choices and data entry, by providing
knowledge-based prompts and access to information about drugs and the patient.
In response to test results, alerts, and requests for correction and clarification,
the clinician adjusts orders and their documentation as required.
CPOE (depending on the degree of sophistication and CDS) supports and improves
the reliability of the prescribing/ordering step by:
Reducing illegibility and transcription errors by eliminating handwriting
Standardizing identifiers, names, and codes of clinical entities: drugs, tests,
and patients by using data dictionaries and
Linking patient-specific data and information to the ordering process
Providing evidence-based order sets
Automating calculations
Providing alerts and reminders
Screening for populations at risk 5
26.4 Pediatric-Specific Technical Features of CPOE/CDS
Different populations of children have different vulnerabilities and safety needs
(Chapters 3–8). Within pediatric care environments, features that should be taken
into consideration when designing or choosing CPOE/CDS systems include:
Universal weight-based dosing
� Automatic drug dose calculations and rounding
� Drug dictionaries with up-to-date pediatric-specific dose information
� Dosing alerts, reminders, and warnings that are age, weight, and drug specific
� Override (“break the glass”) options for specific cases and prescribers
(very high or low weight children, impaired drug absorption or clearance,
differential tolerances in pain management)