Online calculator and chemotherapy order systems reduce medication errors in children

Two new studies from the Johns Hopkins Children's Center show that computerizing ordering of chemotherapy and other types of intravenous drug infusions for children greatly reduces the risk of potentially dangerous medical errors.

An online infusion calculator and a computerized drug ordering system, developed under the leadership of Christoph Lehmann, M.D., director of clinical information technology at the Children's Center, have been in use there for about three years, but this is the first time that researchers have measured their impact on medication errors.

Children in general are three times more likely than adults to be victims of medication errors because both ordering and dosing are more complex in children than adults, according to Lehmann. In children, dosing is based on calculations factoring in age, height and weight, and miscalculations and rounding errors could cause life-threatening harm. Dosing errors also cause more ill effects in children because still-developing bodies absorb, metabolize and excrete drugs at different rates than adults and thus have lower tolerance for medication overdose. Children undergoing treatment for cancer are at even greater risk because the general dangers of potent chemicals are compounded by the dosing challenges.

"Our findings reveal that using a Web-based calculator makes it less likely to order and give a child the wrong dose or commit other errors, such as omitting patient information, weight parameters or infusion rates," explains Lehmann, lead author of the Web-based calculator study, which appears in the May 8 issue of Pediatric Critical Care Medicine. "Our calculator stops ordering errors before they can even reach the pharmacy, let alone the patient."

The calculator computes all doses, advises and warns of drug interactions and automatically offers "default" doses and drug dilutions to help doctors avoid overdosing and under-dosing.

For the study, researchers compar

Contact: Katerina Pesheva
Johns Hopkins Medical Institutions

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