Safety Through Enhanced e-PreScribing Tools (STEPStools): Developing Web Services for Safe Pediatric Dosing

Prescribing medications for children has more complexity than prescribing medications for adults because of the variability in development and physical ability of children. As such, medication errors are a leading reason for childhood iatrogenic morbidity and mortality, in which the medical treatment given is the cause of harm to the child. Current e-prescribing systems have two important gaps which need to be filled to ensure safe prescribing of medications to children: 1) they are unable to automatically round doses, and 2) they do not apply compounded medication knowledge to prescribing. These gaps may inadvertently lead users of e-prescribing systems to under or over dose a given medication, depending on its particular properties. This project sought to create tools to overcome these gaps, and to disseminate those tools once created. The objectives of the project were to:

• Convene a panel of American Academy of Pediatrics (AAP) and American Medical Informatics Association experts to construct a knowledgebase of actionable data to guide e-prescribing systems in the appropriate rounding of calculated doses and selection of extemporaneous medication formulations.
• Develop Web services and Web browser client to allow browsing this knowledgebase.
• Evaluate the usability and content validity of these Web services through a series of pediatric prescribing use-cases, site visits to pilot users, and an examination of the error rate of prescriptions generated with and without the use of these Web services.

The project team successfully developed a knowledgebase specific to medication management for children. The tools created included an algorithm for rounding of medication doses and a compounded medication knowledgebase. The result, called STEPSTools, was integrated into an existing e-prescribing system. Web services were developed so that others could have access to the knowledgebase and to allow distribution of the tools. In the future, the team plans to disseminate the tool and make it publicly available without cost to pediatricians via coordination with the AAP.