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De Wildt et al concentrate on the shortcomings of Excel but ignore other inadequacies.1 Using Excel or other spreadsheets for dose checking (with or without the locking facility) is inappropriate. The problem is not just data going in the wrong place—it is essential that the concepts of strength and dose are not confused, which seems to have occurred in this case, and that every entry is clear, follows accepted standards, and its purpose is clear.
Writing robust software for handling dose calculations is straightforward, but this is not a job just for the computer programmer. The first requirement is to assemble the knowledge domain of the application—in this case, all drug products (and all their details in standardised format) that would ever be needed in paediatrics and the medical information domain for their use (indications, contraindications, side effects, interactions, dosage, and so on). Next the knowledge concepts and related terminology need to be organised, preferably into some form of hierarchical thesaurus and put into a database. Now the algorithm to do the dose checking can be written and checked. Finally the programmer can write the program. This program makes calls to the knowledge domain database on the basis of the strictly controlled entries of the user. The drugs required are selected from the database, ensuring that real products are chosen by the user as are the weight, age, and medical conditions. The knowledge database must contain all the drugs and other treatments including strengths, formulations, dose per kg body weight, dose for specific indications, and routes and rates of administration.
The whole job could be done by a team of one doctor or pharmacist with the necessary knowledge (or at least access to it), one database expert, and one programmer—in one year or in standardised units three man years.
Competing interests: RW is the managing director of SafeScript Ltd and co-author of its product: the World Standard Drug Database