Situation: The DKA calculator we have in Epic pulls weights from prior encounters for the initial insulin infusion dosing and errors have occurred secondary to old/incorrect weights being entered.

Background: Our system has a rule in place for all patients >18 years old that allows for a 2 day lookback at prior encounters for a weight. In some instances, a weight might be inaccurate compared to the weight in the current encounter either due to ‘stated weights’ being used, or differences in scale calibration.

While these differences are often clinically insignificant, there have been situations in which the difference was clinically significant. Further, it is confusing to staff when they see a medication (in this case an insulin drip) being dosed based on a weight that is different from the current encounter weight that appears in chart.

Assessment: The ability for the DKA calculator to utilize old, potentially inaccurate weights to calculate an initial rate of infusion is a safety risk.

Recommendation: We are seeking advice from other systems who might have encountered similar concerns/problems, and interested to know if there are any solutions that have been implemented to either:
1) Prevent the historic weight from being utilized altogether (but that would NOT be a system-level change & apply to all medications)
2) Call attention to care providers (at the ordering, verifying or administration phase) that a weight from the current encounter is NOT being utilized to calculate the dose.

We appreciate any insight :)
Thank you!
Nicole