Medication Dosing

Instead of writing out prescriptions on a piece of paper, doctors will perform this function directly into their electronic medical record.  The prescription travels from their computer to the pharmacy’s computer. Electronic prescriptions are sent electronically through a private, secure, and closed network – the Surescripts network.

Patients are becoming more involved in their own healthcare, and are increasingly making use of patient portals and consumer-facing websites to do research, follow their progress, and even answer questions they might have previously posed to their physician. At the very least, they are using these sites to be more informed during visits to their care providers so they can get more value from those encounters.

All of this creates an opportunity for innovative developers to provide accurate, reliable, easy-to-understand information to patients via the web. One source for medication and clinical information that can be easily integrated into such sites is Lexicomp.

Lexicomp is a leading provider of drug reference, clinical reference, and patient education leaflets and materials to clinicians. Over a thousand hospitals use Lexicomp's information every day during patient encounters. The information available includes medication lists, drug monographs, drug interaction information (including interactions with common food and natural products), drug allergy information, patient education documents, dose adminstration, warnings, and more.

And Lexicomp's information can be easily integrated into your site in a variety of ways. You can choose to have an installed local database, or to use web services to pull information from Lexicomp's servers as needed. Contact Lexicomp today to find out how to populate your patient portal or consumer website with the information your users are looking for.

Pediatric dosing continues to be a major concern among clinicians in almost all practice settings. In fact, those who do not regularly treat children often have the most questions about proper dosing and treatment. One area where EMR, EHR, and HIS systems can meaningfully differentiate themselves is in providing this information.

Physicians, pharmacists and nurses know that children are not simply "little adults". Besides different dosage precautions, children may require different administration or routes -- and for some cases may receive completely different medications. Different patient education leaflets are also needed when treating children.

For these reasons, it's important to partner with a drug information vendor that is well regarded in pediatrics. Lexicomp is the drug reference vendor of choice among U.S. pediatric hospitals, and has specialized in this area for decades. Most clinicians will see children as patients at some point in their work, and they know that this vulnerable population requires special care. Using Lexicomp as a drug vendor can help put their concerns to rest and add value to their EMR, EHR, or HIS system.

• Our Web API solution empowers integration of all Lexicomp content. Consistent API programming calls save time and allow clinicians to launch from their internal applications into our clinical databases, utilizing whatever delivery platform they choose.

• Our Web Services platform is written for compatibility with Microsoft® .NET™ and Java™ programs. XML data can be obtained via standardized calls and is then processed and returned in real-time. Your application will retrieve and parse the content into your display, making complete customization a reality.

• If live Internet calls are not preferred, XML datasets are available for download from an FTP site and incorporated directly into the database.

Having a sick child can be a challenging and stressful time for any parent.  A sick child also presents challenges for health care professionals as well as health information systems as it relates to prescribing medications.  For a number of medications, pediatric dosage calculations are based on weight.  Having a weight available in the community pharmacy setting is often challenging, however this is only the first step in being able to validate the correct dosage range.  The second piece necessary to accurately check the validity of a pediatric prescription is having the correct information in your pharmacy system. 

All too often, community pharmacy systems are not equipped with the necessary drug reference database to accurately evaluate a pediatric dose.  For over 15 years, pediatric practitioners have been using Lexicomp's Pediatric Dosage Handbook and more recently, our electronic versions to prescribe and validate pediatric dosing.  Now, this information has been transformed into a data set that can be integrated into pharmacy systems to allow your HIS to help you validate these critical doses.  For more information about this product, visit http://www.lexi.com/businesses/ehr-vendors/. 

Hospitals are complex organizations with many different systems used by different departments, and often not well integrated. All kinds of errors can occur -- human errors, data-entry errors, labeling errors. And unfortunately, sometimes those errors have fatal consequences, such as this case of a premature infant that received a lethal dose of sodium due to a parenteral nutrition compounding error.

In this particular case, the death was reported to have led from incorrect data entry into the compounder, insufficient oversight by the pharmacist, incorrect labeling, and an unfulfilled physician request for investigation into abnormally high sodium levels in the infant. Though neither the EMR nor the CPOE were directly implicated in the error this time, it's always worth thinking about whether your system would have been capable of preventing this mistake -- and if not, what you may need to change.

Needed: Dose range checking -- and then some
In order for any system to have detected this error, some form of dose range checking would need to have been in place. This wasn't a result of an adverse drug event or an improperly prescribed medication, so Meaningful Use interaction and allergy checking are of no use. Only knowledge of the correct dosage for this specific patient would help.

In fact, not even all dose range checking would be helpful. This patient belonged to a special class -- a neonate. So the dose checking would need to be differentiated between adult and pediatric (or, in this case, neonatal). Otherwise, a dose that would be appropriate for an adult but fatal to an infant could easily be prescribed.

IV compatibility also an issue
This case also dealt with a solution administered intravenously. In this particular case, there was no adverse reaction between the ingredients being compounded, but with IV administration that's always a possible danger. Therefore, to be 100% safe, your EHR or HIS would also need to contain information about IV Y-site compatibility.
 
And of course, all of this would need to be checked and double-checked at every stage of the process by every clinician: the physician entering the order into the CPOE, the pharmacist compounding the solution, and the nurse administering it to the patient. The systems that each clinician uses should be able to check for each of these factors (and more!), and also should be able to provide the clinicians with more "human readable" information in case something doesn't seem right.

With the state of healthcare IT today, most of us are still a long way off from being able to implement a perfectly integrated system that can eliminate this kind of error entirely. But taking a few steps with the systems we have control over can reduce tragic outcomes like this one. One place to start is to contact a clinical and drug information vendor like Lexicomp to find out what information is available to be integrated into your systems -- both transactionally for automatic clinical decision support and as reference material for clinicians to make use of.