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

27 Dispensing: Pharmacy Information Systems 353
interactions or warnings. The usefulness of some of these messages varies, as they
may not be context sensitive. For example, a warning that a specific drug may
cause a false-positive urine toxicology screen is significant only if one is ordered,
otherwise it is noise. Some PharmIS CDS systems may screen warnings appropriately
(such as displaying drug-pregnancy and/or lactation warnings only for female
patients of childbearing age), but in many cases, such warnings are of significance
to the primary clinician (when they are not noise) and would be better included in
a CPOE or eMAR system.
27.3.3.5 Intercepting Drug Incompatibilities (Intravenous
Admixtures)
Incompatibilities of drugs in intravenous (IV) admixtures are undesired but sometimes
chemically predictable phenomena that reduce or negate medication potency (through
precipitation, inactivation, neutralization, absorption, etc.) of an active component of
the mixture. Some incompatibilities depend on relative admixture component concentrations
and other factors (temperature, exposure to light, etc.).
An IV component compatibility screening tool within a PharmIS CDS system
has tremendous usefulness. The ability to check an entire IV profile on-demand
and to provide incompatibility warnings prior to admixture would have great utility.
Currently, systems are hindered by the fact that the necessary calculations that
determine compatibility problems do not occur until the order for the admixture has
been entered. One workaround would be to provide this calculation in CPOE, but
currently, IV compatibility integration into PharmIS CDS is only in its infancy.
27.4 Special Workflows
Certain medication delivery workflows pose greater risk to patients (either higher
likelihood or impact of error), which create the need for special precautions to
reduce errors. Cancer chemotherapy requires complex protocols that may be interrupted
due to the current health status of the patient and drugs of high toxicity.
PharmIS may provide alternative scheduling and lifetime medication dose tracking
for drugs of cumulative toxicity. 11,12 Continuous infusions are frequently used in
critical care and require calculation support as well as the required use of standard
concentrations. 13
27.5 Conclusion
Within pediatric medication delivery processes, the most valuable component of
any pediatric pharmacy process is a qualified and experienced pediatric pharmacist
and pharmacy staff who actively participate in clinical care of inpatients (such daily