May 2012

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Pediatric medication dosing is a complex process with many unique considerations not seen in other healthcare populations. Vendor-supplied dosing rule databases are commercially available for integration within many electronic health records order systems. The accuracy of these rules has not been evaluated in the informatics literature. Inaccurate or absent dosing rules in electronic order entry systems can lead to high numbers of false alerts and potentially compromises patient safety in an already vulnerable population. Quantitative analysis of 7 months of medication orders and alerts from a large pediatric hospital was performed. Thirty medications were selected for study across 5 age ranges and 5 dosing parameters. The resulting 750 dosing rules from a commercial system formed the study corpus and were examined for accuracy against a gold standard created from traditional clinical resources. Overall accuracy of the rules in the study corpus was 55.1% when the rules were transformed to fit a priori age ranges. Over a pediatric lifetime, the dosing rules were accurate an average of 57.6% of the days. Dosing rules pertaining to the newborn age range were as accurate as other age ranges on average, but exhibited more variability in accuracy when evaluated by medication type. Daily frequency dosing parameters showed more accuracy than total daily dose, single daily dose minimum, or single daily dose maximum. This study demonstrates that the accuracy of a vendor-supplied dosing rules database is suboptimal when compared with traditional dosing sources, exposing a gap between formal dosing rules in commercial products and actual prescribing practices by pediatric care providers. More research on vendor-supplied databases is required in order to understand the effects of these products on safe prescribing in children.




School of Medicine



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