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To make absolutely certain that its young patients get the right medications, Children’s National Medical Center in Washington, D.C., requires that nurses double-check certain orders. When ordering high-risk medications like sedatives, narcotics and electrolytes, a nurse must have a colleague sign off that the right dose was selected.

Despite implementing computerized physician order entry and an electronic medication administration record in 2005, the hospital determined that the double-check process wasn’t working, says Susan Stanley, R.N., nursing informatics program manager (see story, page 34). Unfortunately, nurses were sometimes taking short cuts and avoiding complex manual calculations of the right doses, she says.

The CPOE and EMAR, from Cerner Corp., Kansas City, Mo., could not accommodate the sophisticated calculations involved in treating pediatric patients. So the hospital developed its own online calculator.

Stanley worked with one of the hospital’s programmers, Gary Luo, to create a calculation application that displays a list of high-risk medications. Nurses enter into the calculator such information as the patient’s age and weight. The application then displays an adjusted dose that’s appropriate for the patient.

Nurses now access the home-grown calculator through the EMAR and print out the results for recommended doses. “We could not come up with a way to store the calculation, so we print it as evidence the process has been completed,” Stanley says. A witness confirms that a nurse selects the right dose from a Pyxis dispensing cabinet from Cardinal Health, Dublin, Ohio. For example, a nurse might place 2 millileters in a syringe and dispose of the rest.

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