I was not clear what role computers played in the prescription errors
described. It is not surprising that depressed residents made more errors
than did control doctors. The processes of neonatal and indeed paediatric
prescribing are generally much more complex than for adults, whatever the
health status of the doctor. The tolerance of errors may be less in
children and babies. Drug injections for adults often use a half to a
whole standard ampoule, but sick or premature neonates frequently require
only a tiny proportion of the phial, which increases the scope for
accidental and possibly lethal overdosage caused by medical or nursing
error. A sequence of calculations may be required to obtain the correct
dose: the weight of the drug in milligrams or micrograms must be chosen
according to the baby's weight and then adjusted according to factors such
as age, gestation, or renal function. The displacement volume of dissolved
powder or crystals may be relevant when small proportions of a phial are
required. Once the weight of the dose is known, the correct volume of the
solution must be chosen and the dose diluted to obtain a manageable
volume, bearing in mind that a 0.02 ml injection cannot be practically
given and that in multiple drug treatment minimal volumes must be used to
avoid fluid overdose. Each of these stages adds scope for error, however
accurate or user friendly the compendium or formulary, in spite of the use
of an electronic calculator.
In 1996 I reported a computerised system (Reference) that took care
of all these issues, though not of course the state of the prescriber's
health. The system called up all the relevant variables and avoided the
use of a decimal point after a zero. It is obviously obsolete now but
could have been refined at the time by someone more adept than I was.
Nevertheless computerised prescribing could reduce some of the pressures
on healthy and depressed doctors, should increase the safety of paediatric
and neonatal prescribing, and it is worthy of more research.
REFERENCE. Program calculates doses for neonates J M Davies BMJ.com
1996;312:446 (17 February)
Rapid Response:
Inherent difficulty of prescribing for neonates
I was not clear what role computers played in the prescription errors described. It is not surprising that depressed residents made more errors than did control doctors. The processes of neonatal and indeed paediatric prescribing are generally much more complex than for adults, whatever the health status of the doctor. The tolerance of errors may be less in children and babies. Drug injections for adults often use a half to a whole standard ampoule, but sick or premature neonates frequently require only a tiny proportion of the phial, which increases the scope for accidental and possibly lethal overdosage caused by medical or nursing error. A sequence of calculations may be required to obtain the correct dose: the weight of the drug in milligrams or micrograms must be chosen according to the baby's weight and then adjusted according to factors such as age, gestation, or renal function. The displacement volume of dissolved powder or crystals may be relevant when small proportions of a phial are required. Once the weight of the dose is known, the correct volume of the solution must be chosen and the dose diluted to obtain a manageable volume, bearing in mind that a 0.02 ml injection cannot be practically given and that in multiple drug treatment minimal volumes must be used to avoid fluid overdose. Each of these stages adds scope for error, however accurate or user friendly the compendium or formulary, in spite of the use of an electronic calculator.
In 1996 I reported a computerised system (Reference) that took care of all these issues, though not of course the state of the prescriber's health. The system called up all the relevant variables and avoided the use of a decimal point after a zero. It is obviously obsolete now but could have been refined at the time by someone more adept than I was. Nevertheless computerised prescribing could reduce some of the pressures on healthy and depressed doctors, should increase the safety of paediatric and neonatal prescribing, and it is worthy of more research.
REFERENCE. Program calculates doses for neonates J M Davies BMJ.com 1996;312:446 (17 February)
Competing interests: None declared
Competing interests: No competing interests