DoseChecker assists staff pharmacists at Barnes and Jewish Hospitals in St. Louis (teaching hospitals affiliated with Washington University) in monitoring drug orders for a set of drugs which must be carefully dosed for patients with possible renal impairment.

Certain types of drugs require careful quantitative dosing, particularly in patients with renal impairment. In these patients, drug concentrations can build to toxic levels. Drug dosing decisions should focus, then, on maintaining concentrations which maximize therapeutic effects while controlling the risk of toxicity.

Renal function varies over time and can be estimated as a function of calculated creatinine clearance. DoseChecker monitors patients with active orders for drugs known to require careful dosing. Using parameters such as patient weight and serum creatinine, DoseChecker calculates creatinine clearance and applies a set of dosing guidelines developed by pharmacokinetic experts to determine if the dosing is appropriate. If it does not fall within established guidelines, an alert is generated for a pharmacist, who then consults the patient's attending physician to determine whether the dosage should be adjusted.

DoseChecker is made up of a set of dosing guidelines developed by local experts, a relational database containing patient demographic information and clinical data such as serum creatinine measurements and drug orders. Suspected dosing violations are stored so that trends can be detected.

Technologies employed: CLIPS (expert system tool from NASA), Sybase ISQL scripts, Bourne shell scripts.

DoseChecker and PharmADE (another system developed by clinical and medical informatics groups in St. Louis), received a National Hospital Pharmacy Quality Award, presented by Abbott Laboratories in 1998, and were recognized by the Smithsonian Institution in 1999.

Archive of AI systems in clinical practice previously administered by Enrico Coiera. Used with permission. Maintained and extended since 2001 by OpenClinical.