Accuracy imperative in clinical calculationsby Donna Padgette, R.N.Emerald Communications and Training Committee New math, fuzzy math, any number of descriptors come to mind when considering mathematics, but accuracy is the key when it comes to clinical calculations. To that end, a newly revised tool is available thanks to a collaborative effort among clinicians and CCIT’s Patient Support Systems team. The ClinLAN desktop icon, MUSC Calculations, provides a tool to perform a number of calculations, including body surface area, creatinine clearance, fractional excretion of sodium, and serum osmolality. Additional features include a dosing calculator for pediatric emergency drugs and a link to the Mayo Clinic calculator used by the MUSC transplant team. A calculation program was initially provided through Laboratory Services’ Cerner system, delivered first on StatLAN workstations and eventually on ClinLAN workstations. Eileen White, Laboratory Services applications analyst, explains that the need for revision became apparent when reference ranges and formulas could not be modified because the programming code was written in an obsolete language. An option to use the MicroMedex Healthcare Series dosing tools was not chosen, in part because of the benefits that development of a MUSC site could offer, such as control over formulas and site-specific reference ranges. Each clinical calculation page displays the formula upon which the computation is based, in some cases allowing calculation with both metric (centimeters, kilograms, etc.) and customary weights and measures (inches, pounds, etc.). The Measurement Conversions page computes conversions between the two units of measure such as kilograms to pounds, inches to centimeters, degrees centigrade to Farenheit, and vice-versa. Since the program is web-based, results may be copied and pasted into documents or spreadsheets on-line, which wasn’t possible with the previous program. Revisions to the pediatric emergency drug dosing calculator were significant, and include updating the list to reflect the current emergency drug formulary. The revised edition provides for the entry of the patient’s weight, allowing more accurate calculations than were possible using the weight ranges in the previous program. Not only is the correct drug dosage calculated, the appropriate administration information is provided as well, doing away with the need to convert milligrams to milliliters in the heat of the moment. Minimum and maximum doses are noted and are indicated with an asterisk if the calculated dose falls above or below the parameters. “We can enter the child’s name and weight and print the results to be posted at the bedside, readily available in event of an emergency,” said Chap Reynolds, Pharm.D., PICU clinical specialist, who assisted with development of this component and sees the benefits first hand. An addition to the program that’s particularly helpful for the MUSC transplant team is the link to the Mayo Clinic calculator for MELD scores, which indicate the severity of liver disease. With changes to the UNOS allocation system for livers, this complicated calculation determines a patient’s position on the waiting list. “This is much more convenient for us. Before, we had to remember the URL address or get there in a roundabout way through another site,” said Sylvia Odom, R.N., transplant systems analyst and clinical outcomes manager, who requested this addition. Work is underway to provide the MELD score calculations directly from the MUSC calculations page, which will provide the same internal control available for the other calculations. The MUSC Calculations icon is available on ClinLAN workstations, or the page may be accessed through the link http://useweb.musc.edu/jsp/pss/calcs/index.html. For information on this program, contact the CCIT Help Desk at 792-9700. Even the best mathematicians make use of reliable tools to assist in their calculations—now all MUSC clinicians have that option too. Clinical Calculators Web page
Clinical Calculators
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