'Peds are not tiny adults', how do you tell a computer that?

I'm near the end of my clinical pediatric rotation and have had a unique opportunity to look at how clinical information systems (CIS) are used in peds. Everytime I've encountered pediatric medicine someone has stated the dogma of "peds are not tiny adults." That certainly makes sense from a pharmacokinetic perspective, but how do we teach that to our information systems?

Since we use the same computerized provider order entry (CPOE) system and pharmacy system for pediatrics and adults, it creates all sorts of havoc that we must solve. Examples:

• Should you barcode breast milk? If so, how?
• Up until birth, the mother and fetus are treated as '1' patient in the record, do you create another patient record upon birth (*hint* yes, you should)? If so, how? How does this affect your admission, discharge, and transfer (ADT) system?
• How do you handle a drug (eg., cefotaxime) that is formulary for peds and non-formulary for adults in the same system?
• What happens when a drug (eg., desmopressin) intended to be used one route (nasal) is actually used for another (oral)?

These questions if not addressed appropriately can create all sorts of therapeutic and safety problems. A majority of pharmacy related issues specifically concern clinical decision support (CDS) and drug file manipulations.

For clinical decision support, with every rule or advisor you create you must ask yourself "how does this affect peds"? An elaborate adult vancomycin wizard that calculates doses based on population kinetics and troughs may not be relevant to children. Why? "Peds are not tiny adults."

We try to make it easier on pharmacists processing orders by intelligently picking what's in the inventory based on what is ordered through CPOE. However, this may quickly break down when it comes to peds. An order for cefttriaxone in adults may correctly point to the 1gm IV premix. In peds it has to point to a diluted syringe that has to be manually compounded. Throw in variables much as mixed patient units (eg., the ED has children and adults), automated dispensing cabinet inventory, and drug shortages and it quickly degenerates into the IT pharmacist curled up in a fetal position.

We often try to compromise a "one size fits all" when it concerns clinical information systems. However, if we say pediatric patients are not tiny adults, should we only have one system? If so, how do we teach the computer that the kid in the unit is not just a really short adult?

via rxinformatica