Integration of the key potentially inappropriate drugs in pediatrics list within the electronic health record in a tertiary care children's hospital

Introduction

The key potentially inappropriate drugs in pediatrics (KIDs) List raises awareness of medications and excipients that should be used cautiously in specific age groups, appropriately monitored, or avoided. This project used the KIDs List to identify opportunities to improve our clinical decision support program and adjust the medication formulary.

Methods

Our team used the Plan, Do, Study, Act (PDSA) cycle to assess items and take actions that included no change, creation of an alert or task for pharmacists or providers, referral for additional study, inventory modification, and modification of dose range alerts.

Results

Our initial assessment of 34 formulary items identified 10 items (29%) with the recommendations from the KIDs list in place; 72% (24/34) were referred for further study. In the preliminary phase, 15% (5/34) were submitted to pharmacy information technology (IT) to develop an alert, 24% (8/34) needed inventory modifications, 24% (8/34) required dose range alert adjustments, and 9% (3/34) were referred for additional study. Final actions included the development of six new alerts, inventory modification for nine medications, dose range checking for eight medications, and no change for 11 medications.

Discussion

The PDSA cycle was an effective process that allowed the team to assess each medication using a systematic approach and encouraged additional analysis when needed. We were able to compare the KIDs List recommendations to current clinical decision support parameters and make adjustments or develop new alerts within the electronic health record to match the current standard. This initiative had a team-based approach, included key stakeholders, and is replicable in other institutions.