April 3, 2013
Pediatric Group Recommends More E–Prescribing to
Lower Error Rates

Elk Grove Village, IL—With prescribing error rates in children estimated to be between 5% and 27%, with the greatest risk from drugs requiring weight-based dosing, electronic prescribing in pediatrics could significantly improve medication management, according to a new technical report.

The report, published recently in the journal Pediatrics, accompanies a policy statement from the American Academy of Pediatrics recommending the broader adoption of e-prescribing by pediatric health care providers.

The report, “Electronic Prescribing in Pediatrics: Toward Safer and More Effective Medication Management,” points out that medication errors, which are most prevalent with antibiotics but can occur even with medications that do not require weight-based dosing, can be even more dangerous in pediatrics because of narrow therapeutic profiles and the inability of some children to communicate adverse effects.

Study authors cite “limited but positive pediatric data supporting the role of e-prescribing in mitigating medication errors, improving communication with dispensing pharmacists, and improving medication adherence.”

“Physiologic factors, such as the nearly universal need for weight or body surface area considerations in dosing, make medication ordering more prone to errors in children than in adults,” according to the report. “In addition to these physiologic factors, the therapeutic window for many drugs is smaller for children than adults. Pharmacologic factors, including age-based variability in absorption, metabolism, and excretion of drugs in children as compared with adults, as well as the age-specific contraindications of certain medications, pose special vulnerabilities to the adverse effects of overdosing.”

Noting that children’s weight can vary from as little as 500 g for extremely premature infants to more than 100 kg for some obese adolescents, “two patients (1 weighing 2 kg and the other 100 kg) discharged with a prescription for 5 mg/kg per day of ranitidine could receive a dose of between 10 mg and 300 mg a day and still not catch the attention of a pharmacist, because all doses between these amounts are reasonable for children, depending on their weight.”

E-prescribing systems, on the other hand, include standardized dosing formulas
to use the patient’s weight to calculate a dose, to convert that dose to a volume for liquids, and to present that dose in a format that is least likely to be confusing to the prescriber or pharmacist, according to the report. The most sophisticated systems use individual dose limits and total daily dose limits and even write out the final dose to improve clarity, study authors note.

They also point out the role of missing information and illegible prescriptions in prescribing errors, adding that pharmacists have urged pediatric prescribers to follow a format that includes information about the child’s age, weight, and indication for therapy as well as a format (e.g., no trailing zero) that minimizes miscommunication. E-prescribing software “can default or force entry of specific information,” the authors add.

In its accompanying policy statement, the AAP recommends the greater adoption of e-prescribing systems with pediatric functionality.

U.S. Pharmacist Social Connect