These options include:
- Pediatric Dosage Calculations in both transactional information for the clinical decision support systems and reference materials designed for clinicians.
- Pediatric focused patient education materials
Try telling a doctor that she's just like a pharmacist, or a nurse practitioner that he's just like a physician's assistant, and you'll soon find out that the differences between healthcare professionals run wide and deep. Companies that sell drug reference books and drug reference software directly to doctors, pharmacists, nurses, and dentists have long known this -- but do EHR vendors and the suppliers of transactional drug data know it?
In the reference market, you'll find there are different solutions with similar drug interaction and drug reference information marketed to each type of healthcare professional. The underlying information is often the same, but a doctor's first choice would never be a resource designed for a pharmacist, and vice versa.
When spending their own money, healthcare professionals seek out specific resources
The reason for this is simple: Healthcare professionals adamantly will not accept "one-size-fits-all" reference resources! They actively seek out those that have the right level of detail, the right formatting, and the right focus on relevant topics to help them do their jobs quickly, efficiently, and safely.
For example, doctors like to have diagnostic information alongside drug information, but have less need for the in-depth pharmacokinetics and pharmacodynamics that pharmacists often require. Nurses, meanwhile, are most interested in information about proper administration of a drug and patient education. These different needs have driven the evolution of the drug reference market over the past several decades -- don't fool yourself into thinking they won't be important to EHRs as well!
Clinicians are also going to have a huge amount of input into which EHR vendor their hospital or practice partners with. And if they won't accept a generic approach in a drug reference book (retail: $150), you can be sure they won't accept it in a clinical decision support system (retail: $15,000)!
Does your drug information data provider understand this?
Lexi-Comp is the only drug data provider that operates across the entire spectrum of healthcare professionals. Lexi-Comp sells reference resources directly to pharmacists, physicians, nurses, dentists, and specialists -- and they choose Lexi-Comp because of the value they find in resources that are specially tailored to their needs.
Moreover, Lexi-Comp is the only transactional data provider that has such a wide reference user base of pharmacists and clinicians. Imagine the power of partnering with a clinical decision support data provider who already understands what each of your different end users may want! After thirty two years of delighting clinicians with superior reference solutionss, Lexi-Comp knows how to keep delighting them with data. That's something that the "one-size-fits-all" providers can't say.
Pediatric dose calculations represent a particular challenge to some healthcare professionals. A drug reference book can help, but there are additional considerations which are not part of the text. Considerations such as the maturation of the child and nutritional status are not easily factored. In addition, drug interactions may play a role in the adjustment of dose. When using a pediatric dosage calculator, it is important that the medicine list be reviewed, as a calculator typically focuses on only a single medication. Augmenting the decision-making process with drug interaction software can help assess these influences on dosing. Both processes are essential in arriving at an appropriate therapeutic dosage.
Pediatric dosing is a complicated affair. With the increasing trend of childhood obesity in the United States, the risks of ordering and administering improper doses also increases. Additionally there are the complicating factors of physiological development - pediatric patients cannot be dosed as "little adults." There are a number of well regarded pediatric drug reference books available, however when choosing one of these resources it is important to understand the publisher's editorial model. Do they have pediatric specialists as authors and editors? How frequently is the information reviewed and updated? Does it contain easy to read pediatric dosing charts that can be highly useful in reviewing medications across a drug class?
Additionally, there is an emerging approach to pediatric dosing through the use of drug content, both referential and transactional data. Pediatric dose range checking functionality can be associated with content used to support electronic medical records. The advantage to this publishing model is the frequency with which updates can be made - rather than waiting for the next edition of a reference to be printed, the on-line information can be updated at any time. However the same questions should be considered with an electronic format of information: who are the authors and how frequently is the body of content reviewed? Special care should be taken when choosing any source of information for pediatric dosing.
Alteration of dose should be approached with an appreciation for several key factors. Other factors should be considered related to dosage administration. A drug reference book is only a starting point. One should not be so cautious about drug dosing that the therapeutic benefit of the drug is lost. Inadequate dosing may lead to treatment failure. Accumulation related to impaired elimination requires repeated dosing. In evaluating possible risks of accumulation, it is also important to balance the timing of drug accumulation, and the relationship of elevated concentrations to specific adverse effects. Drugs which are dosed for a very limited period of time, or drugs which have wide therapeutic “windows”, may not warrant much in the way of dosage adjustment.
The initial dose of a regimen is often not adjusted, serving as a “loading” dose to achieve therapeutic response. Subsequent dosage may be adjusted by lengthening the interval or reducing the size of an individual dose. Different drug classifications may require different dosing adjustment strategies. It is important to employ a strategy which does not compromise the efficacy of the drug – so drugs which need high “peaks” for efficacy should generally be adjusted by interval, while drugs which need a continuous presence in the serum should be adjusted by the size of the individual dose.
Selection of an alternative which is hepatically metabolized may be an option, but one must consider metabolites as a part of evaluation. For example, Morphine and meperidine are hepatically metabolized, but each has a metabolite which accumulates in renal impairment. In the case of morphine, additional sedation/respiratory depression may result. Meperidine’s metabolite results in neuroexcitation, potentially leading to seizures with repeated dosing. However, a single dose of either agent is not likely to result in harm. Other metabolites which may be of concern include NAPA, and desmethyldiaepam.
The implementation of electronic health records (EHR) claims to help reduce medical errors by providing healthcare professionals with clinical decision support. Some of the existing EHR providers in the hospital setting have the software architecture that allows the hospital to choose the drug data knowledge base that the hospital prefers to use however, there are other EHR providers in the hospital setting that force the hospital to use the drug data knowledge source without any choice. Drug data is a critical component that has an impact on healthcare costs and the overall quality of patient care, so having the ability to select which knowledge base should be a consideration of the EHR vendor.
I have had discussions with various hospitals that are not satisfied with their current EHR provider's drug knowledge base and have expressed an interested in evaluating other drug data resources such as Lexi-Data.
Lexi-Comp offers a solution called Lexi-Data that contains decision support information such as drug interaction software (drug-drug and drug-food), drug allergy checking, therapeutic duplication checking, dose range checking (adult and pediatric) and more. Lexi-Data also contains drug reference book information, dose administrations, dosage precautions, dosing in pediatrics, and much more. Delivery options include database tables that are compatible with Oracle, SQL Server, and MySQL and an easily implemented Software Development Kit (SDK) powered by Jav or .NET APIs.