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Int J Med Inform. 2015 Feb;84(2):134-40. doi: 10.1016/j.ijmedinf.2014.11.005. Epub 2014 Nov 18.

Prescription order risk factors for pediatric dosing alerts.

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Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, United States. Electronic address:
Center for Biostatistics, Ohio State University, Columbus, OH, United States. Electronic address:
Institute of Therapeutic Innovations and Outcomes, College of Pharmacy, Professor Emeritus of Pharmacy, Pediatrics, and Medicine, Colleges of Pharmacy and Medicine, OSU and Nationwide Children's Hospital, Columbus, OH, United States. Electronic address:



To determine dosing alert rates based on prescription order characteristics and identify prescription order risk factors for the occurrence of dosing alerts.


A retrospective analysis of inpatient medication orders and dosing alerts occurring during October 2011 and January, April, and July 2012 at a pediatric institution. Prescription orders and alerts were categorized by: medication class, patient age, route of administration, and month of the year.


There were 228,259 orders during the studied period, with 11,072 alerted orders (4.9%). The most frequently alerted medication class was the non-analgesic central nervous system agent class (14% of alerts). Age, route, medication class, and month all independently affected dosing alert rates. The alert rate was highest for immunosuppressive agents (54%), neonates (6.7%), and orders for rectal administration (9.5%). The alert rate was higher in adult patients receiving their care at a pediatric institution (5.7%) compared to children (4.7%), but after multivariate analysis, pediatric orders had higher odds for an alert (OR 1.1, 95% CI 1.05-1.16). Mercaptopurine had the highest alert rate when categorized by active ingredient (73.9%). Albuterol 2.5mg/mL continuous aerosol and heparin 1000 units in 0.9% sodium chloride injection solution were the unique medications with the highest alert rates (100.0% and 97.7%, respectively).


Certain types of prescription orders have a higher risk for causing dosing alerts than others. Patient age, medication class, route of administration, and the month of year can affect dosing alert rates. Design and customization efforts should focus on these medications and prescription order characteristics that increase the risk for dosing alerts.


Administration and dosage; Clinical decision support system; Information technology; Medical order entry systems; Medication errors; Pediatrics; Prescriptions

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