Evaluation of medication dose alerts in pediatric inpatients
Abstract
Objective This study evaluates the impact of 12,093 consecutive dose alerts generated by a computerized provider order entry system on pediatric medication ordering.Patients and methods All medication orders entered and all resulting medication dose alerts at the Johns Hopkins Children's Medical and Surgical Center in 2010, were retrospectively evaluated. Inclusion criteria were hospitalized patients less than 21 years old. There were no exclusion criteria.Results During 2010, there were 7738 admissions for 5553 unique patients. A total of 182,308 medication orders for 1092 unique medications were submitted by providers. Six percent (11,155) of orders or order attempts generated alerts for 2046 patients and 524 medications. Two categories of alerts were analyzed: dose range alerts and informational alerts. 73.4% (8187) of all alerts were dose range alerts, with a compliance rate of 8.5% (694); 26.6% (2968) were informational alerts, with a compliance rate of 5.5% (163).Conclusions We found that underdosing alerts provide less value to providers than overdosing alerts. However, the low compliance with the alerts should trigger the evaluation of clinical practice behavior and the existing alert thresholds. Informational alerts noting the absence of established dosing guidelines had little effect on provider behavior and should be avoided when building a dose range alert system.
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Similar override rates of over 90% have been found in drug dose alerts.
“Similar override rates of over 90% have been found in drug dose alerts [21].”
From Drug interaction alert override rates in the Meaningful Use era: No evidence of progress (2014) · cites this paper as [21]
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- Authors
- Scharnweber, C., Lau, B. D., Mollenkopf, N., Thiemann, D. R., Veltri, M. A., & Lehmann, C. U.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- Johns Hopkins University (US)
- Vanderbilt University (US)
- Corresponding author
- Lehmann, Christoph U.
- Venue
- International Journal of Medical Informatics
- Publisher
- Elsevier BV
- Published
- 2013-08
- Volume
- 82
- Issue
- 8
- Pages
- 676-683
- ISSN
- 1386-5056 (ISSN-L)
- OpenAlex
- W2040218371
- Cited by
- 26
- References
- 40
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2021: 2 · 2020: 1 · 2019: 4 · 2018: 3 · 2017: 2 · 2016: 1 · 2015: 5 · 2014: 3
- FWCI
- 5.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Medical Informatics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Surgery › Healthcare Technology and Patient Monitoring
- Keywords
- computerized physician order entry, hospitalized children, alarm thresholds, dosing recommendations, medication ordering
- MeSH terms
- Adolescent, Adult, Child, Child, Preschool, Drug Therapy, Computer-Assisted, Female, Humans, Infant, Infant, Newborn, Male, Medication Errors, Reminder Systems, Medical Order Entry Systems, Drug Dosage Calculations, Young Adult, Tertiary Care Centers
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