680: MEDICATION DOSING IN CRITICALLY ILL OBESE PEDIATRIC AND ADULT PATIENTS: A QUALITY INITIATIVE

Introduction: Emerging evidence supports the use of alternative dosing weights for medications in obese patients and could lead to a reduction in serious adverse events. Pediatric obesity presents a particular challenge as most medications are dosed on mg/kg or mg/m2 basis. Secondarily, building system-wide pediatric obesity safeguards is difficult due to pediatric obesity definitions of body mass index (BMI)-percentile-for-age via CDC growth charts. Here we describe the intensive care unit (ICU) data from a quality initiative (QI) at a large, freestanding children’s hospital. The specific aim was to increase appropriate dosing of seven intravenous (IV) medications in obese patients > 2 years old admitted to the ICU from 36.9% to >73.8% and sustain for 1 year. Methods: Electronic medical record (EMR) functionality (EPIC Systems, Inc) was built to identify obese pediatric patients based on CDC obesity definitions. In obese patients, clinical decision support (CDS) was built with an opt-out default selection of the appropriate alternative weight when medication was ordered. Following implementation of the EMR functionality, medication orders for IV acetaminophen, dexmedetomidine, IV acyclovir, IV aminoglycosides, and IV voriconazole for obese patients were assessed for appropriate dosing weights of adjusted or ideal body weight. Data was analyzed using statistical process control charts. Results: 506 medication orders were reviewed for appropriateness of dosing weight in the year prior to implementation of CDS and 401 medication orders were reviewed in the 8 months post implementation. Patient’s age, sex, BMI, and the percentage of orders for each medication were comparable between pre and post intervention groups. In obese pediatric and adult patients admitted to the ICU, appropriate medication dosing increased from 36.9% to 81.5% after implementation of CDS in the EMR and no adverse safety events were reported. Conclusions: We improved appropriateness of medication dosing for obese ICU patients by >100% from the pre-CDS baseline using a novel, QI-based approach. This initiative demonstrates the effectiveness of CDS for adjusted medication doses in obese pediatric and adult ICU patients. Further study is needed to determine the clinical and safety outcomes associated with this change in dosing strategy.