In a major milestone for paediatric patient safety, West London Children’s Healthcare (WLCH) has become what is believed to be the first NHS organisation to implement all four requirements set out in new joint guidance from the Royal College of Paediatrics and Child Health (RCPCH) and Neonatal and Paediatric Pharmacy Group (NPPG) for safe paediatric electronic prescribing.
This is the culmination of a long-running clinical collaboration between WLCH — the combined service for children and young people at Chelsea and Westminster Hospital NHS Foundation Trust and Imperial College Healthcare NHS Trust — and Dosium to embed nationally governed, patient-specific prescribing directly within clinical workflows.
Clinicians using Dosium’s Touchdose decision support tool for prescribing can now send complete, patient-specific medication orders — including indication, dose, route, and frequency — directly into the Cerner Millennium Electronic Patient Record (EPR) for clinician review and sign off. The dosing logic is generated using BNFC-based prescribing guidance and local guidelines, adjusted for each patient’s specific needs.
Medication errors are a major challenge in paediatric prescribing owing to the complexities of weight-based dosing, age-specific formulations and the need for precise calculations. Previously, prescribers manually transcribed dosing recommendations into the EPR, a critical juncture where selection or copying errors can occur. The development builds on two years of work between WLCH and Dosium to improve paediatric prescribing safety and efficiency. According to a study of 1,808 medication orders during that period, prescribing error rates decreased from 7.1% to 1.2% when the decision support tool was used.
There are around 237 million medication errors in England each year, resulting in more than 18,000 avoidable NHS bed days, according to national estimates.
Guidance published earlier this year by the Joint RCPCH and NPPG Medicines Committee outlines four core requirements for safe paediatric electronic prescribing. WLCH is believed to be the first NHS organisation to operationalise all four within a live prescribing workflow.
Advancing safer and more efficient prescribing
Paediatric prescribing is significantly more complex than adult prescribing, with doses needing to be tailored to the individual child based on weight, age, body surface area, clinical indication, renal function, and both local and national formulary guidance.
Traditionally, electronic prescribing has relied on a combination of static, generic "order sentences”, external guidance, manual calculations, and local prescribing rules to identify and apply the correct dose for an individual child. This often requires clinicians to search for the appropriate dosing guidance separately before manually entering the prescription into the EPR.
By contrast, WLCH’s newly integrated workflow embeds BNFC-governed and local guideline-informed, patient-specific dosing logic directly within the existing EPR process, removing administrative friction while maintaining strict human oversight and final clinical sign-off.
Staff feedback has been positive, and financial modelling suggests substantial future potential cost savings and avoidance associated with this safer, more efficient prescribing.
Nicola Vosser, Principal Pharmacist ePMA – IT Applications, said: “I am so excited about what we’re doing here because it’s the first time I’ve seen something in the system that is specifically designed for paediatric prescribing. The way we have historically built drug systems is all about adults, but it doesn’t easily translate to children because doses are tailored to each child. There isn't a standard dose to compare against, which makes errors much harder to spot and limits how much safety support we can build into existing systems.
“This new integrated workflow with Touchdose takes away those complicated manual steps and delivers a fantastic level of precision, all without taking decision-making away from clinicians.”
Supporting the future of NHS prescribing
While interoperability has long been an NHS priority, few organisations have yet demonstrated this level of live integration between governed prescribing decision support and enterprise EPR workflows.
Nicholas Appelbaum, CEO and co-founder of Dosium, said: “This milestone is important not just for West London Children’s Healthcare, but for the future direction of NHS prescribing infrastructure. We’ve shown that it is possible to embed governed, patient-specific formulary governance directly into prescribing workflows in a way that supports clinicians, reduces variation, and improves safety.
“Ultimately, this is about helping clinicians make safer decisions more easily, while creating a stronger connection between national prescribing guidance and frontline care.”
By demonstrating that this type of live prescribing integration is achievable within existing NHS infrastructure, WLCH provides an early example of what future safer paediatric prescribing infrastructure could look like across the NHS.
WLCH and Dosium hope to support wider progress towards safer, more connected prescribing workflows across the NHS.
.png)
