Considerations: The concern has been reviewed by multiple provincial area councils pre-launch. Medication margins of error, measurement confidence intervals, decision-support dependencies, reconfiguration-burden and validation and practices elsewhere were considered. Worries about narrow therapeutic windows were explored.
Solution: Pharmacy, Critical Care and Child Health stakeholders carefully considered the issues and Wave 1 clinical system design review pathways were activated. A decision is made to:
- Continue with two digit rounding for volumes of liquid oral medications <1ml; and one digit rounding for volumes >1ml
- Monitor a list of 22 liquid oral medications flagged for possible administration problems
- Make available a work-around that simulates two-digit rounding with linked orders, while limiting its use because of clinical decision support impacts.
- Review and reconsider after 6-8 weeks experience with the current build.