Decision Support Platform Facilitates Morphine Precision Dosing in Neonates
Published October 2019 | Clinical Pharmacology & Therapeutics
Managing pain in neonatal patients—most commonly with the opioid morphine—is a delicate balancing act. Rapid physiological changes, life-sustaining procedures, and patients’ inability to describe their symptoms can make it difficult to provide individualized morphine dosing.
To help providers make data-informed decisions, experts at Cincinnati Children’s developed NeoRelief, a decision support platform embedded in the electronic health record (EHR).
Traditionally, the process of morphine dosing is iterative—from a wide range of starting doses, adjustments are made empirically based on clinical response, side effects, pain scores, and levels of sedation. Because neonates vary in their ability to clear morphine, they experience a wide range of exposures, which are poorly predicted by dose alone.
The team, led by Kevin Dufendach, MD, MS, and first author Sander Vinks, PharmD, PhD, tackled this challenge with a user-friendly approach to decision support. NeoRelief translates morphine dose into a pharmacokinetic profile and exposure. Simultaneously, the application depicts markers of response and clinical events in the form of pains scores, heart rate, and respiratory rate.
A visual dashboard of this feedback is accessible directly from the EHR, providing actionable information at the time of medication ordering and facilitating precision dosing for each individual patient. Researchers expect that NeoRelief will improve pain management and reduce the risk of harm from side effects and opioid dependence.
“This project demonstrates our first successful build of an EHR-integrated clinical decision support application,” Dufendach says. “Next, we will measure the effect of implementing this clinical decision support application into clinical care. Our hypothesis is that regular use of this tool will result in fewer pro re nata (PRN) doses of morphine and lower total morphine exposure in neonates.”
