Incorporation of a gentamicin dosage calculator into a computerized prescriber-order-entry system

The health care industry has become increasingly aware of public concerns regarding inappropriate medication use and patient safety,1 and hospital pharmacists have become more focused on methods to prevent or reduce the medication-prescribing behavior that can compromise patient safety.2 Appropriate dosage determination for aminoglycosides helps to achieve desirable levels of drug in the blood, thereby reducing the probability of ototoxicity, nephrotoxicity, and treatment failure. The majority of physicians in our intensive care unit (ICU) previously based gentamicin dosage on previous experience, textbook recommendations, or the patient’s estimated creatinine clearance (CLcr) value. The high percentage of dosages that led to trough concentrations of ≥2 μg/mL and peak concentrations of <4 μg/mL indicated a high probability that errors were occurring in dosage calculations, probably because of limited references and the complexity of the pharmacokinetic equations. The availability of a pharmacokinetic calculation feature on the hospital computer system was therefore anticipated to assist physicians in ordering more appropriate dosages of aminoglycosides and to help reduce medication errors and adverse drug events.3 Thus, we incorporated equations from pharmacokinetics textbooks4,5 into our computerized prescriber-order-entry (CPOE) system.