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Effect of a weight-based prescribing method within an electronic health record on prescribing errors.

PURPOSE
The effect of a weight-based prescribing method within the electronic health record (EHR) on the rate of prescribing errors was studied.


METHODS
A report was generated listing all patients who received a prescription by a clinic provider for either infants' or children's acetaminophen or ibuprofen from January 1 to July 28, 2005 (preintervention group) and from July 29 to December 30, 2005 (postintervention group). Patients were included if they were 12 years old or younger, had a prescription ordered for infants' or children's acetaminophen or ibuprofen within the EHR, and had a weight documented in the chart on the visit day. The dosing range for acetaminophen was 10-15 mg/kg every four to six hours as needed, and the regimen for ibuprofen was 5-10 mg/kg every six to eight hours as needed. Dosing errors were defined as overdosage of strength, overdosage of regimen, underdosage of strength, under-dosage of regimen, and incomprehensible dosing directions.


RESULTS
Totals of 316 and 224 patient visits were analyzed from the preintervention and postintervention groups, respectively. Significantly more medication errors were found in the preintervention group than in the postintervention group (103 versus 46, p = 0.002). Significantly fewer strength overdosing errors occurred in the postintervention group (8.9% versus 4.0%, p = 0.028).


CONCLUSION
An automated weight-based dosing calculator integrated into an EHR system in the outpatient setting significantly reduced medication prescribing errors for antipyretics prescribed to pediatric patients. This effect appeared to be strongest for reducing overdose errors.