Evaluation of medication dose alerts in pediatric inpatients

• This study provides an in depth analysis of provider responses to pediatric dose range alerts.
• We illustrate the need to evaluate practice behavior and alert thresholds in existing dose range alerting system.
• Minimum alerts provide less value to providers than maximum alerts.
• Alerts indicating that there were no established dosing guidelines had no effect on provider behavior.
• Medical services are more likely to respond to dose range alerts than surgical.

ObjectiveThis study evaluates the impact of 12,093 consecutive dose alerts generated by a computerized provider order entry system on pediatric medication ordering.Patients and methodsAll medication orders entered and all resulting medication dose alerts at the Johns Hopkins Children's Medical and Surgical Center in 2010, were retrospectively evaluated. Inclusion criteria were hospitalized patients less than 21 years old. There were no exclusion criteria.ResultsDuring 2010, there were 7738 admissions for 5553 unique patients. A total of 182,308 medication orders for 1092 unique medications were submitted by providers. Six percent (11,155) of orders or order attempts generated alerts for 2046 patients and 524 medications. Two categories of alerts were analyzed: dose range alerts and informational alerts. 73.4% (8187) of all alerts were dose range alerts, with a compliance rate of 8.5% (694); 26.6% (2968) were informational alerts, with a compliance rate of 5.5% (163).ConclusionsWe found that underdosing alerts provide less value to providers than overdosing alerts. However, the low compliance with the alerts should trigger the evaluation of clinical practice behavior and the existing alert thresholds. Informational alerts noting the absence of established dosing guidelines had little effect on provider behavior and should be avoided when building a dose range alert system.