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 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. According to a study of 1,808 medication orders over two years of work between WLCH and Dosium, prescribing error rates decreased from 7.1% to 1.2% when the decision support tool was used. [1]

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. [2]

Guidance published earlier this year by the Joint RCPCH and NPPG Medicines Committee sets out four core requirements for safe paediatric electronic prescribing. WLCH is the first NHS organisation to operationalise all four within a live prescribing workflow. [3]

Advancing safer and more efficient prescribing

Paediatric prescribing is significantly more complex than adult prescribing, with doses 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. This often requires clinicians to search for 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.

Nicola Vosser, Principal Pharmacist ePMA, said it is “the first time I’ve seen something in the system that is specifically designed for paediatric prescribing. There isn’t a standard dose to compare against, which makes errors much harder to spot.”

“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.”

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Nicola Vosser

Principal Pharmacist ePMA, IT Applications

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.

“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.”

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Nicholas Appelbaum

CEO and co-founder, Dosium

By demonstrating that this type of live prescribing integration is achievable within existing NHS infrastructure, WLCH provides an early example of what safer paediatric prescribing infrastructure could look like across the NHS.