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Clinical rulesets

Clinical rulesets control dose, infusion, fluid, and equipment suggestions. They do not replace clinical judgment and they never create a medication event without a clinician action.

Which ruleset is used​

Adult and pediatric rulesets are selected independently. LOSPOR resolves one complete ruleset for the active mode in this order:

  1. the clinician's selected personal ruleset;
  2. the institution's selected ruleset; then
  3. the LOSPOR platform ruleset.

The first available published ruleset wins. LOSPOR does not combine individual rules from several levels, and it never falls back from Pediatric to Adult. This makes the origin of every suggestion unambiguous.

Who can change rules​

  • A platform administrator can create, edit, publish, and select platform rulesets.
  • A head of department can copy an accessible ruleset, edit the copy, publish it, and select it for the institution.
  • An individual user can copy an accessible ruleset, edit the copy, publish it, and select it as a personal ruleset.

Published rulesets are immutable. To change one, create and publish a new copy. The copy records the source ruleset and source version. Imported literature references are retained when a ruleset is copied or its payload is edited. Pediatric policy rows also carry a review state and rationale; source review is not the same as clinical approval.

Full editing is available in the web application. Mobile and PWA settings show the currently effective Adult and Pediatric rulesets, their scope and version, and whether the displayed copy came from the live API or offline cache.

Canonical administration routes​

LOSPOR stores canonical route codes and displays translated clinical names:

IV, IM, SC, PO, IN, PR, INHALATION, TOPICAL, TRANSDERMAL, INFILTRATION, PERINEURAL, EPIDURAL, INTRATHECAL, INTRAOSSEOUS, and ENDOTRACHEAL.

Legacy aliases such as PD, IT, IO, and ET are normalized when read. Sublingual (SL) is not part of the anesthesia ruleset vocabulary.

Canonical dose units​

The amount vocabulary is ng, mcg, mg, g, IU, mmol, mEq, and mL. A dose may use no body-size basis, total body weight, ideal body weight, or body surface area. Time bases are none, per minute, or per hour.

LOSPOR keeps a UCUM representation internally so future exports and integrations can compare units without guessing from display text. The user interface continues to show familiar clinical units.

Platform baseline​

LOSPORADULTS Rules is the canonical Adult platform baseline. It is generated from the existing authored anesthesia option library and contains:

  • 181 drug profiles;
  • 48 infusion profiles;
  • 22 fluid profiles; and
  • one Adult equipment policy.

The Pediatric v1 platform draft contains a policy ledger for all 181 drugs, three conservative route profiles, 41 equipment suggestions, and 28 equipment policy rows. It remains unpublished and unselected until every policy has been clinically approved. See Pediatric platform draft. Manual documentation remains available; Adult suggestions are never reused.

Rule sets v3 (9.15.0)​

Release 9.15.0 adds an adult v3 (267 rules; v2 has 251) and a paediatric v3 (367 rules; v2 has 335).

  • Upgrade: both are installed on the upgrade beside v2, in the same transaction.
  • Selection: the platform selection moves from v2 to v3 only where the 1.2.0 release made it. A ruleset an institution or a clinician selected stays selected.
  • v2 unchanged: the v2 rows stay exactly as installed, and their fingerprints still verify.

What v3 changes:

  • Drug groups: drugs are regrouped by their primary use, and the colours follow the group.
  • Regional adjuvants: their own intrathecal, epidural and perineural doses. A route with its own settings never borrows another route's calculation.
  • 15 more infusions: midazolam, remimazolam, clonidine, thiopental, morphine, urapidil, methylene blue, tranexamic acid, potassium chloride, calcium gluconate and chloride, sodium bicarbonate, hydrocortisone, pantoprazole and somatostatin. Also epidural fentanyl (mcg/hr).
  • Units: amiodarone in mg/hr, and magnesium sulfate for children in mg/kg/hr.
  • Children:
    • every drug and infusion band gets a suggestion, a range and pills;
    • local anaesthetic infusions are entered in mL/kg/hr, limited by dose;
    • some drugs are hidden for children only, for example ibuprofen under 3 months and obstetric drugs under 12 years.

Offline behavior​

Clients cache the last successfully downloaded published ruleset separately for each user and clinical mode. If the API is unavailable, that cached copy may be used and is visibly marked as offline. Clinical-rule caches are cleared at logout.