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The research presented in the ‘Smartphone Use for Paediatric Calculations in Emergencies’ (SPaCE) study by Dr Jordan Evans and colleagues sheds light on this issue, suggesting that embracing digital solutions could significantly improve healthcare prescribing safety and efficiency.1 The SPaCE study evaluated emergency calculation methods, including smartphone apps, reference charts and traditional calculations. Furthermore, the integration of generative artificial intelligence and machine learning models into healthcare proposes an exciting frontier for medication error reduction and clinical decision support.6 While studies investigating the use of machine learning have been undertaken, evaluation and validation are required before its widespread implementation as a prediction or clinical decision support tool in EHRs. Scepticism about the initial costs and learning curves associated with digital solutions often overlooks the long-term benefits, such as time and resource savings and the potential to save lives by reducing prescribing errors.
Correspondence to Dr Hadeel Hassan; [email protected]
In today’s digital age, it is surprising to see the continued reliance on manual calculations and prescribing in paediatrics, a field that stands to gain significantly from the integration of technology. The research presented in the ‘Smartphone Use for Paediatric Calculations in Emergencies’ (SPaCE) study by Dr Jordan Evans and colleagues sheds light on this issue, suggesting that embracing digital solutions could significantly improve healthcare prescribing safety and efficiency.1
The SPaCE study evaluated emergency calculation methods, including smartphone apps, reference charts and traditional calculations. Its findings align with prior research indicating lower error rates with digital tools compared with conventional methods. Notably, smartphone apps surpassed both traditional and chart-based calculations in accuracy. However, the authors acknowledged potential blinding and measurement biases that could impact the findings. They also noted that the simulation-based nature of the study may affect its reproducibility in real-life settings. Nonetheless, this study still demonstrates the importance of adopting digital solutions for prescribing. This approach could minimise human errors from manual calculations and drug dosing, while also improving efficiencies.
Paediatric prescribing is fraught with challenges, such as the need for precise, individualised dosing, raising the risk of errors like decimal point mistakes and dosage confusion. Traditionally, healthcare professionals have relied on manual or calculator-based methods for these calculations, which can be problematic, especially in high-pressure environments. A systematic review extrapolated that up to 50 000 paediatric dosing errors occur per year in England,2 highlighting the urgent need to reduce dosing errors.
Various digital solutions have emerged with the potential to revolutionise paediatric dosing practices that can reduce prescribing errors. These range from Excel sheet templates with embedded formulas to web applications and smartphone apps, providing portable access to dosing calculators and drug information. However, these tools face limitations, including a lack of integration with patient records, susceptibility to input errors and a dependence on developers’ commitment to maintaining up-to-date information. Studies have also suggested that electronic prescribing may not prevent all harmful prescribing errors.3
Interoperability in healthcare is also a key advancement in the digital enhancement of paediatric prescribing. It enables different information technology systems and software applications to communicate, exchange data and effectively use this information. This capability is essential for integrating electronic health records (EHRs) with e-prescribing tools and Computerized Physician Order Entry systems. By streamlining access to patient history, facilitating drug interaction checks, and automating dosing calculations, interoperability significantly reduces error risk, thereby enhancing patient safety and prescribing efficiency. Achieving this level of system integration requires considerable investment and commitment to ensuring that various systems and applications can work together seamlessly. This collaborative effort is vital to share and update patient information in real time, a cornerstone of accurate and efficient prescribing practices.
Despite the prevalence of electronic patient records across 90% of NHS trusts in the UK, only 27% have fully embraced electronic prescribing.4 This gap represents a missed opportunity to leverage digital solutions to reduce paediatric dosing errors, which is a critical concern. In countries like Canada and the USA, electronic prescribing with automated dosing calculations has shown promise in enhancing safety and reducing adverse events, as highlighted by a report from the American Academy of Paediatrics.5 The report stated that $2 billion per year is saved from the universal adoption of electronic prescribing due to the reduction of adverse events and the report acknowledged that computerised prescribing could prevent patient errors.
Furthermore, the integration of generative artificial intelligence and machine learning models into healthcare proposes an exciting frontier for medication error reduction and clinical decision support.6 While studies investigating the use of machine learning have been undertaken, evaluation and validation are required before its widespread implementation as a prediction or clinical decision support tool in EHRs.
The UK’s slower adoption reflects broader challenges such as cost, system errors, the need for expertise and data security concerns. Meanwhile, smartphone apps emerge as a temporary solution, offering quick, error-minimised dosing calculations. However, they are not without their own limitations, including the risk of input errors under stress and the necessity for regular updates and validation to ensure reliability between different hospitals.
The transition to electronic prescribing also brings to the forefront the debate of electronic versus manual calculations. Scepticism about the initial costs and learning curves associated with digital solutions often overlooks the long-term benefits, such as time and resource savings and the potential to save lives by reducing prescribing errors. Electronic prescribing systems offer precision and speed, essential in emergency situations, yet the importance of maintaining proficiency in manual calculations cannot be understated. Healthcare providers must be prepared for any technical failures or situations where electronic systems, web applications or smartphone apps may not be available.
The incorporation of technology in paediatric care, as evidenced by the SPaCE study, goes beyond mere adaptation to digital trends—it signifies a proactive stride towards enhancing care quality and patient safety. Addressing the challenge of interoperability not just technologically but also through a cultural shift within healthcare organisations towards more collaborative and integrated approaches to patient care is pivotal. Encouraging the development of standardised data formats and promoting the use of open platforms can facilitate this transition, making it smoother and more effective.
In conclusion, transitioning to digital prescribing solutions in paediatric care is both a necessity and an opportunity. It represents a chance to reduce human error, augment efficiency, and ultimately, deliver superior care to paediatric patients. Embracing this evolution necessitates meticulous planning and thoughtful execution. The potential benefits for patient safety and healthcare efficiency are substantial, making this endeavour a worthwhile pursuit for the future of paediatric prescribing. However, digital tools are designed to complement, not substitute, the expertise of healthcare professionals. By doing so, they play a crucial role in maintaining and enhancing the highest standards of paediatric care.
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Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer-reviewed.
1 Evans J, Morrison Z, Thomas-Turner R, et al. Smartphone use for paediatric calculations in emergencies (SPaCE). Arch Dis Child 2024; 109: 282–6. doi:10.1136/archdischild-2023-326180
2 Wong ICK, Ghaleb MA, Franklin BD, et al. Incidence and nature of dosing errors in paediatric medications. Drug Safety 2004; 27: 661–70. doi:10.2165/00002018-200427090-00004
3 Fox A, Portlock J, Brown D. Electronic prescribing in paediatric secondary care: are harmful errors prevented? Arch Dis Child 2019; 104: 895–9. doi:10.1136/archdischild-2019-316859
4 Best J. NHS still reliant on paper patient notes and drug charts despite electronic upgrades, the BMJ finds. BMJ 2023; 382: 2050. doi:10.1136/bmj.p2050
5 Gerstle RS, Lehmann CU, Technology the C on CI. Electronic prescribing systems in pediatrics: the rationale and functionality requirements. Pediatrics 2007; 119: e1413–22. doi:10.1542/peds.2007-0889
6 King CR, Abraham J, Fritz BA, et al. Predicting self-intercepted medication ordering errors using machine learning. PLoS One 2021; 16: e0254358. doi:10.1371/journal.pone.0254358
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