Does a Dose Calculator as an Add-On to a Web-Based Paediatric Formulary Reduce Calculation Errors in Paediatric Dosing? A Non-Randomized Controlled Study.

Autor: van der Zanden TM; Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands. t.vanderzanden@erasmusmc.nl.; Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands. t.vanderzanden@erasmusmc.nl.; Dutch Knowledge Center Pharmacotherapy for Children, The Hague, The Netherlands. t.vanderzanden@erasmusmc.nl., de Hoog M; Intensive Care and Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.; Dutch Knowledge Center Pharmacotherapy for Children, The Hague, The Netherlands., Windster JD; Intensive Care and Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands., van Rosmalen J; Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands., van der Sijs IH; Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands., de Wildt SN; Intensive Care and Department of Paediatrics, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands.; Department of Pharmacology and Toxicology, Radboud University, Nijmegen, The Netherlands.; Dutch Knowledge Center Pharmacotherapy for Children, The Hague, The Netherlands.
Jazyk: angličtina
Zdroj: Paediatric drugs [Paediatr Drugs] 2020 Apr; Vol. 22 (2), pp. 229-239.
DOI: 10.1007/s40272-020-00386-3
Abstrakt: Objectives: The structured digital dosing guidelines of the web-based Dutch Paediatric Formulary provided the opportunity to develop an integrated paediatric dose calculator. In a simulated setting, we tested the ability of this calculator to reduce calculation errors.
Methods: Volunteer healthcare professionals were allocated to one of two groups, manual calculation versus the use of the dose calculator. Professionals in both groups were given access to a web-based questionnaire with 14 patient cases for which doses had to be calculated. The effect of group allocation on the probability of making a calculation error was determined using generalized estimated equations (GEE) logistic regression analysis. The causes of all the erroneous calculations were evaluated.
Results: Seventy-seven healthcare professionals completed the web-based questionnaire: thirty-seven were allocated to the manual group and 40 to the calculator group. Use of the dose calculator resulted in an estimated mean probability of a calculation error of 24.4% (95% CI 16.3-34.8) versus 39.0% (95% CI 32.4-46.1) with use of manual calculation. The mean difference of probability of calculation error between groups was 14.6% (95% CI 3.1-26.2; p = 0.013). In a secondary analysis where calculation error was defined as a 10% or greater deviation from the correct answer, the corresponding figures were 19.5% (95% CI 13-28.2) versus 26.5% (95% CI 21.6-32.1) with a mean difference of 7% between groups (95% CI 2.2-16.3; p = 0.137). Juxtaposition, typo/transcription errors and non-specified errors were more frequent as cause of error in the calculator group; exceeding the maximum dose and wrong correction for age were more frequent in the manual group. The percentage of tenfold errors was 3.1% in the manual group and 3.7% in the calculator group.
Conclusions: Our study shows that the use of a dose calculator as an add-on to a web-based paediatric formulary can reduce calculation errors. Furthermore, it shows that technologies may introduce new errors through transcription errors and wrongly selecting parameters from drop-down lists. Therefore, dosing calculators should be developed and used with special attention for selection and transcription errors.
Databáze: MEDLINE
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