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

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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)
338 C.U. Lehmann and G.R. Kim Special patient identification support features � Correct patient identification during ordering � Consistent and safe management for disambiguating siblings in multiple births � Reconciliation of name changes for infants and children Pediatric-specific pharmacy and administration infrastructure (see Chapters 27, 28) � Up-to-date pediatric drug information in a CPOE-usable form � An experienced, knowledgeable pediatric pharmacist and pharmacy staff � Adequate training and support for dispensing equipment appropriate to pediatric care needs (total parenteral nutrition, continuous infusions, chemotherapy) � Adequate nursing education and support for administration equipment appropriate to pediatric care needs (smart pumps, appropriate drug forms for pediatric use) Pediatric-specific physiologic, developmental, and pharmacologic data and knowledge � Growth chart data, with adjustments for prematurity and special conditions (preferably incorporated into CDS) � On-demand/just-in-time medical knowledge and patient-specific data ( electronic record/digital library/formulary access) � Enforcement of timely medication reconciliation Increased dosing and decision support in specific risk situations � Redundant calculation and rounding support for patients with very low weights � Calculation support for standard concentration infusions � Smart pumps to deliver very small volumes accurately 26.5 Assessing a CPOE/CDS System for Pediatric Use Adoption of CPOE/CDS for a pediatric inpatient environment is a team effort that requires a structured and inclusive approach by institutional leadership and clinical users (prescribers, pharmacists, nurses) within the environment: 26.5.1 Pre-Adoption (What Needs to Be Improved and Why?) 1. What types of medication errors occur within a given unit? For which medication? 2. What are the rates of such errors in prescribing, dispensing, and administering drug doses? If not known, what are realistic estimates (or how could they be measured)?
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Health Informatics (formerly Comput
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Editors Christoph U. Lehmann George
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vi Series Preface changes to both t
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viii Foreword This text will prove
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x Preface financial investment and
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How to Use This book This book is t
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xvi Contents 9 Pediatric Care, Safe
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xviii Contents Part VII A Vision an
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xx Contributors Donna M. D’Alessa
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xxii Contributors Christoph U. Lehm
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xxiv Contributors Mark M. Simonian,
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4 G.R. Kim pharmacy, medical educat
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6 K.B. Johnson and G.R. Kim Deaths
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8 K.B. Johnson and G.R. Kim 2.4.1 I
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10 K.B. Johnson and G.R. Kim 2.4.3
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12 K.B. Johnson and G.R. Kim Educat
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14 K.B. Johnson and G.R. Kim 2.6 Co
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Chapter 3 Core Pediatric Data Kevin
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3 Core Pediatric Data 21 3.3 Pediat
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3 Core Pediatric Data 23 3.6 Pediat
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Chapter 4 Neonatal Care and Data De
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4 Neonatal Care and Data 27 Essenti
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4 Neonatal Care and Data 29 4.3 The
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4 Neonatal Care and Data 31 some ma
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4 Neonatal Care and Data 33 Measure
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4 Neonatal Care and Data 35 4.5.2.4
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4 Neonatal Care and Data 37 4.6.3 I
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4 Neonatal Care and Data 39 4.7.2.2
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4 Neonatal Care and Data 41 Availab
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44 D.M.N. Paperny Tasks related to
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46 D.M.N. Paperny Behavioral risk d
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48 D.M.N. Paperny for outside ancil
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50 D.M.N. Paperny Video reinforceme
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52 D.M.N. Paperny 3. Litzelman DK,
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Chapter 6 Children with Development
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6 Children with Developmental Disor
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Chapter 7 Pediatric Emergency and P
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7 Pediatric Emergency and Pediatric
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84 W.H. Drummond et al. A recovery
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86 W.H. Drummond et al. 8.2.2 Forma
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88 W.H. Drummond et al. 8.2.2.1 Sys
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90 W.H. Drummond et al. The multidi
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92 W.H. Drummond et al. noise overl
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94 W.H. Drummond et al. needs requi
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96 W.H. Drummond et al. Children’
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98 W.H. Drummond et al. After the P
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100 W.H. Drummond et al. Table 8.2
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104 W.H. Drummond et al. when to su
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106 W.H. Drummond et al. It is crit
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108 W.H. Drummond et al. traditiona
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110 W.H. Drummond et al. and human
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112 W.H. Drummond et al. blood prod
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116 W.H. Drummond et al. 35. Collin
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Chapter 9 Pediatric Care, Safety, a
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9 Pediatric Care, Safety, and Stand
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134 D.M. D’Alessandro The EBM pro
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136 D.M. D’Alessandro 10.4 Pragma
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138 D.M. D’Alessandro 4. Case ser
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140 D.M. D’Alessandro Ontario, BC
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142 D.M. D’Alessandro Table 10.1
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144 D.M. D’Alessandro Children ar
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146 D.M. D’Alessandro 17. Ely JW,
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Chapter 11 Clinical Practice Guidel
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11 Clinical Practice Guidelines: Su
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162 M.J. Feldman in patients withou
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164 M.J. Feldman The art of medicin
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166 M.J. Feldman important design g
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168 M.J. Feldman Incorrect or missi
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170 M.J. Feldman Fig. 12.4 GIDEON D
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172 M.J. Feldman system or etiology
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174 M.J. Feldman ED-12: “Practica
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176 M.J. Feldman Fig. 12.7 DXplain:
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178 M.J. Feldman For GIDEON: Rabies
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180 M.J. Feldman KB on infectious d
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182 M.J. Feldman 4. Johnson KB, Fel
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Chapter 13 Managing Pediatric Knowl
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13 Managing Pediatric Knowledge Res
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Chapter 14 Supporting Continuing Pe
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14 Supporting Continuing Pediatric
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14 Supporting Continuing Pediatric
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Chapter 15 Pediatric Care Coordinat
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15 Pediatric Care Coordination: The
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Chapter 16 Prioritizing Pediatric I
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16 Prioritizing Pediatric Investmen
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Chapter 17 Aligning Pediatric Ambul
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17 Aligning Pediatric Ambulatory Ne
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258 G.R. Kim and C.U. Lehmann Elect
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260 G.R. Kim and C.U. Lehmann 18.2.
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262 G.R. Kim and C.U. Lehmann There
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264 G.R. Kim and C.U. Lehmann 13. C
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266 K.B. Johnson and C.G.M. Weigle
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280 C. Sable et al. computer for la
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282 C. Sable et al. Table 20.3 Tele
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390 D.C. Stockwell and A.D. Slonim
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400 J.H. Schneider a number of prob
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402 J.H. Schneider on governance, u
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404 J.H. Schneider 31.6.1 Data Rele
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408 J.H. Schneider of this componen
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412 J.H. Schneider References 1. Am
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Chapter 32 Developing Pediatric Dat
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32 Developing Pediatric Data Standa
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430 G.R. Kim and S.T. Rosenbloom Co
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432 G.R. Kim and S.T. Rosenbloom No
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434 G.R. Kim and S.T. Rosenbloom pr
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436 G.R. Kim and S.T. Rosenbloom ab
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Chapter 34 Pediatric Research and I
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34 Pediatric Research and Informati
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Chapter 35 The Moving Picture of Pe
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35 The Moving Picture of Pediatric
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470 G.R. Kim and K.B. Johnson Cente
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472 G.R. Kim and K.B. Johnson 36.4
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Index A 2006 AAP recommendations on
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Index 477 psychological data, 45 se
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Index 479 High frequency flow inter
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Index 481 O Online Mendelian Inheri
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Index 483 Standards development org
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