1. Learning Objectives Case Presentation Teaching Points For Case Case Presentation (Cont.) Increase comfort in placing weight based orders for medications and IVF. Recognize that certain medications have minimum and maximum doses. Understand the importance of prescribing medications in doses that are deliverable by nurses or parents. Question You are caring for a 22 kg, 7 year old child with a fever and a barking cough. On exam, the patient has stridor at rest and moderate respiratory distress. You diagnose croup and order: oral Decadron, oral Tylenol, and a racemic epinephrine neb. Answer The dose of Decadron is 0.6 mg/kg for croup. To prescribe oral Decadron, use the 10 mg/1 ml IV formulation – and dose 0.6 mg/kg up to a maximum dose of 10 mg. This child will receive 10 mg of oral Decadron (mixed in cherry syrup). Be sure to change the route to PO. Background Medication error is one of the most frequent problems plaguing patient care, especially in pediatric patients requiring weight based dosing. Appropriate weight based dosing is a difficult skill to acquire due to of a lack of specific training in the EMR, poor system architecture design for practical ordering, and novice learners unaware of potential pitfalls of the EMR. Faculty, nurses, and ED pharmacists identified common sources of errors and designed a curriculum to address these inadequacies in training. Educational Objectives Provide residents with the skills required to safely order weight based medications in realistic volumes and doses using the EMR. Focus on potential safety gaps inherent to an order entry system.. Curricular Design Patient scenarios were developed in which learners were asked to order commonly prescribed pediatric weight based medications that were identified as “at risk for error” orders. A virtual learning environment was created within the EMR “playground”. Learners completed 6 cases in small groups with each learner responsible for a single order entry. At the conclusion of the session, faculty led a review of all orders, types of errors commonly encountered, and demonstrated correct order entry techniques emphasizing systems based issues and strategies to avoid errors. The content was reinforced through a time lapsed review of the learning objectives. Impact/Effectiveness Pediatric faculty, nurses, and pharmacists described a decrease in the numbers of errors frequently made when prescribing pediatric weight based medications. They noted a decreased need to clarify minimum and maximum doses and reported spending less time correcting impractical medication orders. Residents felt that they were more confident in ordering pediatric weight based medications using the EMR. This workshop highlighted the danger inherent in using a weight based medication order entry system in the pediatric population. The principles can be extrapolated to a wide range of medications not covered specifically in the scenarios. Future goals would include increasing the time allocated for the workshop, availability of the workshop to non-EM resident learners, and implementation of a formal milestone based assessment of competency. When in doubt about dosing please ask, look it up, or contact the pharmacist (e.g., Decadron dose). Choose a dose that can be easily administered based on available concentrations. Some medications have a minimum or a maximum dose. Linda Spillane MD, Lee Marks MD, Ryan Bodkin MD, Flavia Nobay MD University of Rochester Medical Center The EMR Playground as a Platform to Train Novice Learners in Safely Ordering Weight Based Medications Conclusions This workshop proved beneficial in emphasizing potential sources of error using an EMR. Qualitatively, faculty and nurses noticed a subsequent decrease in errors for newer trainees, as compared to the past. Trainees felt more comfortable using the EMR for pediatric medication dosing.

2. Learning Objectives Case Presentation Teaching Points For Case Case Presentation (Cont.) Increase comfort in placing weight based orders for medications and IVF. Recognize that certain medications have minimum and maximum doses. Understand the importance of prescribing medications in doses that are deliverable by nurses or parents. Question You are caring for a 22 kg, 7 year old child with a fever and a barking cough. On exam, the patient has stridor at rest and moderate respiratory distress. You diagnose croup and order: oral Decadron, oral Tylenol, and a racemic epinephrine neb. Answer The dose of Decadron is 0.6 mg/kg for croup. To prescribe oral Decadron, use the 10 mg/1 ml IV formulation – and dose 0.6 mg/kg up to a maximum dose of 10 mg. This child will receive 10 mg of oral Decadron (mixed in cherry syrup). Be sure to change the route to PO. When in doubt about dosing please ask, look it up, or contact the pharmacist (e.g., Decadron dose). Choose a dose that can be easily administered based on available concentrations. Some medications have a minimum or a maximum dose. Linda Spillane MD, Lee Marks MD, Ryan Bodkin MD, Flavia Nobay MD University of Rochester Medical Center The EMR Playground as a Platform to Train Novice Learners in Safely Ordering Weight Based Medications Conclusions This workshop proved beneficial in emphasizing potential sources of error using an EMR. Qualitatively, faculty and nurses noticed a subsequent decrease in errors for newer trainees, as compared to the past. Trainees felt more comfortable using the EMR for pediatric medication dosing. Case Presentation 

3. Learning Objectives Case Presentation Teaching Points For Case Case Presentation (Cont.) Increase comfort in placing weight based orders for medications and IVF. Recognize that certain medications have minimum and maximum doses. Understand the importance of prescribing medications in doses that are deliverable by nurses or parents. Question You are caring for a 22 kg, 7 year old child with a fever and a barking cough. On exam, the patient has stridor at rest and moderate respiratory distress. You diagnose croup and order: oral Decadron, oral Tylenol, and a racemic epinephrine neb. Answer The dose of Decadron is 0.6 mg/kg for croup. To prescribe oral Decadron, use the 10 mg/1 ml IV formulation – and dose 0.6 mg/kg up to a maximum dose of 10 mg. This child will receive 10 mg of oral Decadron (mixed in cherry syrup). Be sure to change the route to PO. When in doubt about dosing please ask, look it up, or contact the pharmacist (e.g., Decadron dose). Choose a dose that can be easily administered based on available concentrations. Some medications have a minimum or a maximum dose. Linda Spillane MD, Lee Marks MD, Ryan Bodkin MD, Flavia Nobay MD University of Rochester Medical Center The EMR Playground as a Platform to Train Novice Learners in Safely Ordering Weight Based Medications Conclusions This workshop proved beneficial in emphasizing potential sources of error using an EMR. Qualitatively, faculty and nurses noticed a subsequent decrease in errors for newer trainees, as compared to the past. Trainees felt more comfortable using the EMR for pediatric medication dosing. Case Presentation (Cont.) 

4. Learning Objectives Case Presentation Teaching Points For Case Case Presentation (Cont.) Increase comfort in placing weight based orders for medications and IVF. Recognize that certain medications have minimum and maximum doses. Understand the importance of prescribing medications in doses that are deliverable by nurses or parents. Question You are caring for a 22 kg, 7 year old child with a fever and a barking cough. On exam, the patient has stridor at rest and moderate respiratory distress. You diagnose croup and order: oral Decadron, oral Tylenol, and a racemic epinephrine neb. Answer The dose of Decadron is 0.6 mg/kg for croup. To prescribe oral Decadron, use the 10 mg/1 ml IV formulation – and dose 0.6 mg/kg up to a maximum dose of 10 mg. This child will receive 10 mg of oral Decadron (mixed in cherry syrup). Be sure to change the route to PO. When in doubt about dosing please ask, look it up, or contact the pharmacist (e.g., Decadron dose). Choose a dose that can be easily administered based on available concentrations. Some medications have a minimum or a maximum dose. Linda Spillane MD, Lee Marks MD, Ryan Bodkin MD, Flavia Nobay MD University of Rochester Medical Center The EMR Playground as a Platform to Train Novice Learners in Safely Ordering Weight Based Medications Conclusions This workshop proved beneficial in emphasizing potential sources of error using an EMR. Qualitatively, faculty and nurses noticed a subsequent decrease in errors for newer trainees, as compared to the past. Trainees felt more comfortable using the EMR for pediatric medication dosing. 

5. Learning Objectives Case Presentation Teaching Points For Case Case Presentation (Cont.) Increase comfort in placing weight based orders for medications and IVF. Recognize that certain medications have minimum and maximum doses. Understand the importance of prescribing medications in doses that are deliverable by nurses or parents. Question You are caring for a 22 kg, 7 year old child with a fever and a barking cough. On exam, the patient has stridor at rest and moderate respiratory distress. You diagnose croup and order: oral Decadron, oral Tylenol, and a racemic epinephrine neb. Answer The dose of Decadron is 0.6 mg/kg for croup. To prescribe oral Decadron, use the 10 mg/1 ml IV formulation – and dose 0.6 mg/kg up to a maximum dose of 10 mg. This child will receive 10 mg of oral Decadron (mixed in cherry syrup). Be sure to change the route to PO. When in doubt about dosing please ask, look it up, or contact the pharmacist (e.g., Decadron dose). Choose a dose that can be easily administered based on available concentrations. Some medications have a minimum or a maximum dose. Linda Spillane MD, Lee Marks MD, Ryan Bodkin MD, Flavia Nobay MD University of Rochester Medical Center The EMR Playground as a Platform to Train Novice Learners in Safely Ordering Weight Based Medications Conclusions This workshop proved beneficial in emphasizing potential sources of error using an EMR. Qualitatively, faculty and nurses noticed a subsequent decrease in errors for newer trainees, as compared to the past. Trainees felt more comfortable using the EMR for pediatric medication dosing. 

6. Learning Objectives Case Presentation Teaching Points For Case Case Presentation (Cont.) Increase comfort in placing weight based orders for medications and IVF. Recognize that certain medications have minimum and maximum doses. Understand the importance of prescribing medications in doses that are deliverable by nurses or parents. Question You are caring for a 22 kg, 7 year old child with a fever and a barking cough. On exam, the patient has stridor at rest and moderate respiratory distress. You diagnose croup and order: oral Decadron, oral Tylenol, and a racemic epinephrine neb. Answer The dose of Decadron is 0.6 mg/kg for croup. To prescribe oral Decadron, use the 10 mg/1 ml IV formulation – and dose 0.6 mg/kg up to a maximum dose of 10 mg. This child will receive 10 mg of oral Decadron (mixed in cherry syrup). Be sure to change the route to PO. Background Medication error is one of the most frequent problems plaguing patient care, especially in pediatric patients requiring weight based dosing. Appropriate weight based dosing is a difficult skill to acquire due to of a lack of specific training in the EMR, poor system architecture design for practical ordering, and novice learners unaware of potential pitfalls of the EMR. Faculty, nurses, and ED pharmacists identified common sources of errors and designed a curriculum to address these inadequacies in training. Educational Objectives Provide residents with the skills required to safely order weight based medications in realistic volumes and doses using the EMR. Focus on potential safety gaps inherent to an order entry system.. Curricular Design Patient scenarios were developed in which learners were asked to order commonly prescribed pediatric weight based medications that were identified as “at risk for error” orders. A virtual learning environment was created within the EMR “playground”. Learners completed 6 cases in small groups with each learner responsible for a single order entry. At the conclusion of the session, faculty led a review of all orders, types of errors commonly encountered, and demonstrated correct order entry techniques emphasizing systems based issues and strategies to avoid errors. The content was reinforced through a time lapsed review of the learning objectives. Impact/Effectiveness Pediatric faculty, nurses, and pharmacists described a decrease in the numbers of errors frequently made when prescribing pediatric weight based medications. They noted a decreased need to clarify minimum and maximum doses and reported spending less time correcting impractical medication orders. Residents felt that they were more confident in ordering pediatric weight based medications using the EMR. This workshop highlighted the danger inherent in using a weight based medication order entry system in the pediatric population. The principles can be extrapolated to a wide range of medications not covered specifically in the scenarios. Future goals would include increasing the time allocated for the workshop, availability of the workshop to non-EM resident learners, and implementation of a formal milestone based assessment of competency. When in doubt about dosing please ask, look it up, or contact the pharmacist (e.g., Decadron dose). Choose a dose that can be easily administered based on available concentrations. Some medications have a minimum or a maximum dose. Linda Spillane MD, Lee Marks MD, Ryan Bodkin MD, Flavia Nobay MD University of Rochester Medical Center The EMR Playground as a Platform to Train Novice Learners in Safely Ordering Weight Based Medications Conclusions This workshop proved beneficial in emphasizing potential sources of error using an EMR. Qualitatively, faculty and nurses noticed a subsequent decrease in errors for newer trainees, as compared to the past. Trainees felt more comfortable using the EMR for pediatric medication dosing.