BMJ  2007;334:851-852 (21 April), doi:10.1136/bmj.39104.625903.80

Practice

Lesson of the week

Information technology cannot guarantee patient safety

Saskia N de Wildt, paediatrician1, Ron Verzijden, information technology management consultant2, John N van den Anker, neonatologist and clinical pharmacologist3, Matthijs de Hoog, paediatric intensivist1

1 Department of Paediatrics, Erasmus MC Sophia Children's Hospital, Rotterdam, Netherlands, 3015 GJ, 2 Ron Verzijden Management Consultants, Toronto, Canada M5J 2Y5, 3 Division of Pediatric Clinical Pharmacology, Children's National Medical Center, Washington DC, 20010, USA

Correspondence to: S N de Wildt, Hospital for Sick Children, Division of Clinical Pharmacology and Toxicology, Toronto, ON, Canada M5G 1X8 s.dewildt@erasmusmc.nl

Human error and software inadequacy can combine to make drug doses calculated on hand held computers unreliable

The first 150 words of the full text of this article appear below.

Information technology tools, such as those used to calculate drug doses and infusion rates, can help reduce adverse events and prevent errors.1 Drug dosages for children are usually calculated on the basis of weight. Calculations are especially prone to error and delay in crisis situations such as resuscitation. In such settings, computer based tools may improve clinical care, although human error can still occur, as illustrated by this case report.

A 3 month old infant who arrived at the emergency department of a small regional hospital had clinical signs of meningococcal sepsis with petechiae, purpura, and shock. The infant was subsequently transferred to our paediatric intensive care unit. During transfer the patient was given infusions of dobutamine and noradrenaline by the transferring intensivist. The concentrations of 12 drugs that might be needed for infusion during transport had previously been calculated in the intensive care unit by the resident. This had . . . [Full text of this article]


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This article has been cited by other articles:

  • Weeks, R. L (2007). Software must be robust. BMJ 334: 916-916 [Full text]  

Rapid Responses:

Read all Rapid Responses

Lesson of the week re-interpreted
Roger L Weeks
bmj.com, 22 Apr 2007 [Full text]
Simple Sums, Not The Meaning of the Universe
William T Stevenson
bmj.com, 24 Apr 2007 [Full text]
Could I please support Dr Roger Weeks 100%?
Jim Page
bmj.com, 23 Apr 2007 [Full text]
RE: information technology cannot guarantee patient safety.
Saskia N. de Wildt, et al.
bmj.com, 8 May 2007 [Full text]
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