Related Experiment Video
Updated: Aug 12, 2025
X-ray Dose Reduction through Adaptive Exposure in Fluoroscopic Imaging
Published on: September 11, 2011
Impact of a clinical decision support system on paediatric drug dose prescribing: a randomised within-subject
Lukas Higi1,2, Raffael Schmitt3, Karin Käser2
1Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland lukas.higi@unibas.ch.
Insights
A clinical decision support system (CDSS) significantly reduces pediatric drug dosing errors and speeds up prescribing. The PEDeDose system proved safer and more efficient than manual calculations using product information.
Area of Science:
- Pediatric pharmacology
- Clinical informatics
- Patient safety
Background:
- Drug dosing errors are a major cause of preventable harm in children.
- Human factors contribute significantly to these errors due to complex pediatric pharmacotherapy and demanding healthcare environments.
- Clinical decision support systems (CDSS) offer a promising strategy to prevent prescribing errors.
Purpose of the Study:
- To compare the accuracy and efficiency of a CDSS (PEDeDose) against traditional methods for pediatric drug dose calculation.
- To evaluate the impact of a CDSS's built-in calculator versus manual calculation using product information.
Main Methods:
- A randomized within-subject trial involving 52 healthcare professionals (HCPs) simulating dose derivation for 18 hypothetical pediatric cases.
- Comparison of the CDSS PEDeDose (with built-in calculator) against the Summary of Product Characteristics (SmPC) with a pocket calculator.
- Assessment of dose calculation errors and time required for each method.
Main Results:
- The odds of an erroneous dosage were 12 times higher when using the SmPC with a pocket calculator compared to the CDSS (OR 0.08, 95% CI 0.02 to 0.36, p<0.001).
- Dosage derivation using the CDSS resulted in a 45% reduction in time (95% CI 39% to 51%, p<0.001).
- Using the CDSS without its built-in calculator did not significantly reduce errors, highlighting the importance of the integrated tool.
Conclusions:
- The CDSS PEDeDose demonstrates superior safety and efficiency compared to manual dose calculation in pediatrics.
- Relying solely on a dosing database without an integrated calculator is insufficient for substantial error reduction.
- The CDSS PEDeDose is expected to enhance safety and expedite the prescribing process in clinical practice.
Background:
Drug dosing errors are among the most frequent causes of preventable harm in paediatrics. Due to the complexity of paediatric pharmacotherapy and the working conditions in healthcare, it is not surprising that human factor is a well-described source of error. Thus, a clinical decision support system (CDSS) that supports healthcare professionals (HCP) during the dose prescribing step provides a promising strategy for error prevention.
Methods:
The aim of the trial was to simulate the dose derivation step during the prescribing process. HCPs were asked to derive dosages for 18 hypothetical patient cases. We compared the CDSS PEDeDose, which provides a built-in dose calculator to the Summary of Product Characteristics (SmPC) used together with a pocket calculator in a randomised within-subject trial. We assessed the number of dose calculation errors and the time needed for calculation. Additionally, the effect of PEDeDose without using the built-in calculator but with a pocket calculator instead was assessed.
Results:
A total of 52 HCPs participated in the trial. The OR for an erroneous dosage using the CDSS as compared with the SmPC with pocket calculator was 0.08 (95% CI 0.02 to 0.36, p<0.001). Thus, the odds of an error were 12 times higher while using the SmPC. Furthermore, there was a 45% (95% CI 39% to 51%, p<0.001) time reduction when the dosage was derived using the CDSS. The exploratory analysis revealed that using only PEDeDose but without the built-in calculator did not substantially reduce errors.
Conclusion:
Our results provide robust evidence that the use of the CDSS is safer and more efficient than manual dose derivation in paediatrics. Interestingly, only consulting a dosing database was not sufficient to substantially reduce errors. We are confident the CDSS PEDeDose ensures a higher safety and speeds up the prescribing process in practice.
More Related Videos
Related Concept Videos
01:21Factors Affecting Drug Response: Overview
01:15Drug Dosage Regimen: Overview
Typically, the starting dose and dosing interval are guided by the manufacturer's recommendations based on clinical trials conducted during and after drug...
01:01Dosage Regimen: Fixed Dose
Fixed-dose regimens can be used for various routes of administration, including intravenous (IV) injections and oral medications. For IV administration, a predetermined amount of the drug is...
01:23Types of Biopharmaceutical Studies: Controlled and Non-Controlled Approaches
Non-controlled studies, commonly employed for initial exploration, lack a control group, rendering them susceptible to biases and external influences. In contrast,...
01:22Dose-Response Relationship: Potency and Efficacy
00:56One-Compartment Open Model for IV Bolus Administration: Estimation of Clearance
In the one-compartment open model for intravenous (IV) bolus administration, clearance is estimated by dividing the elimination rate by the plasma drug concentration. This equation leverages the elimination rate constant and the apparent...