This article is more than 5 years old. Information may no longer be current.
AAP recommends e-prescribing
Click Here to Manage Email Alerts
The AAP recently recommended that pediatric health care providers adopt the practice of e-prescribing, according to a policy statement published in Pediatrics.
The AAP said e-prescribing systems for children should include pediatric-specific medication catalogues, pediatric-specific decision support, ingredient amount-to-volume conversions for liquid medications, metric-only labeling instructions, and pediatric drug information and formulation options.
Further, the AAP adds that e-prescribing should include drug interaction and allergy checking; provide patients and parents with instructions based on health literacy and language; pharmacies should enhance their technology to enable efficient processing of e-prescriptions; insurers should offer incentives to providers and pharmacies for using the system; and states should harmonize legislation to the US Drug Enforcement Agency’s interim final rule on e-prescribing of controlled substances.
In a recent systematic review, pediatric prescribing is responsible for an error rate in children between 5% and 27%, and authors of the report said e-prescribing would recognize the inherent challenges of this flaw. Many pharmacologic factors, including age-based variability in absorption, metabolism and excretion of drugs in children, may cause overdosing in children more often than in adults.
“Prescribing errors are most prevalent with antibiotic agents, but may occur even in medications that do not require weight-based dosing or ingredient-to-volume conversion,” Kevin B. Johnson, MD, MS, and colleagues said. “Medication errors in children may lead to more severe complications because of the inability of children to communicate some adverse effects.”
Researchers said past studies that evaluated e-prescribing systems showed consistent reductions in potential adverse events in systems that organize and report medication summaries. E-prescribing systems also can display results of a patient’s previous therapy to help avoid ineffective or harmful medications.
Dosing errors also are common in pediatrics, according to the AAP report. Dosing error-checking is complicated in children because weights vary from as little as 500 g for premature infants to more than 100 kg for obese adolescents. According to researchers, e-prescribing systems use the patient’s weight to calculate a dose, convert it to a volume for liquids, and present it in a format that is not likely to be confusing to a prescriber, pharmacist, nurse or parent.
Researchers also said e-prescribing may help decrease delays in renewals and flagging renewals as inappropriate.
“In pediatrics, there is an additional challenge of modifying a dose for some medication refills as the child grows, which can be facilitated by information technology” Johnson and colleagues said. “Perhaps the most pervasive way that e-prescribing can boost practice efficiency is by recognizing the distributed nature of work in the ambulatory setting.”
Two statutes specifically addressed the goal of 100% e-prescribing adoption by time-dependent incentives and penalties: the Medicare Improvements for Patients and Providers Act (MIPPA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). Under MIPPA, physicians who implemented the technology in 2009 received a 2% increase in payments phasing down to 0.5%. However, any physicians who do not implement in 2014 and afterward will lose 2% of their payments.
Under HITECH, financial incentives are provided to physicians who use health information technology.
Disclosure: The researchers report no relevant financial disclosures.
Click Here to Manage Email Alerts