TY - JOUR
T1 - Computerized order entry with limited decision support to prevent prescription errors in a PICU
AU - Kadmon, Gili
AU - Bron-Harlev, Efrat
AU - Nahum, Elhanan
AU - Schiller, Ofer
AU - Haski, Gali
AU - Shonfeld, Tommy
PY - 2009/9
Y1 - 2009/9
N2 - OBJECTIVE: The value of computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) in preventing prescription errors in pediatrics is unclear. We investigated the change in prescription error rates with the introduction of CPOE with and without a CDSS limited to weight-based dosing in a PICU. METHODS: In a PICU of a major tertiary-care pediatric medical center, 5000 orders were reviewed, that is, 1250 orders from each of 4 periods: period 1, before CPOE implementation; period 2, 1 year after CPOE implementation; period 3, after CDSS implementation; and period 4, after a change in prescription authorization. Prescription errors were identified and classified into: potential adverse drug events (ADEs), medication prescription errors (MPEs), and rule violations (RVs). RESULTS: We identified 273 errors (5.5%). The rate of potential ADEs decreased slightly between periods 1 and 2 (from 2.5% to 2.4%) and significantly in periods 3 and 4 (to 0.8% and 0.7%, respectively; P<.005). The rate of MPEs decreased slightly between periods 1 and 2 (from 5.5% to 5.3%), but new types of MPEs appeared. There was a significant decrease in period 3 (to 3.8%; P < .05) and a dramatically significant decrease in period 4 (to 0.7%; P<.0005). Only 3 RVs were found. Interrater agreement (κstatistic) was 0.788 between evaluators. CONCLUSIONS: CPOE implementation decreased prescription errors only to a small extent. However, the addition of a CDSS that limits doses by weight significantly reduced prescription error rates and, most importantly, potential ADEs. This finding emphasizes the major impact of weight-based calculation errors in pediatrics.
AB - OBJECTIVE: The value of computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) in preventing prescription errors in pediatrics is unclear. We investigated the change in prescription error rates with the introduction of CPOE with and without a CDSS limited to weight-based dosing in a PICU. METHODS: In a PICU of a major tertiary-care pediatric medical center, 5000 orders were reviewed, that is, 1250 orders from each of 4 periods: period 1, before CPOE implementation; period 2, 1 year after CPOE implementation; period 3, after CDSS implementation; and period 4, after a change in prescription authorization. Prescription errors were identified and classified into: potential adverse drug events (ADEs), medication prescription errors (MPEs), and rule violations (RVs). RESULTS: We identified 273 errors (5.5%). The rate of potential ADEs decreased slightly between periods 1 and 2 (from 2.5% to 2.4%) and significantly in periods 3 and 4 (to 0.8% and 0.7%, respectively; P<.005). The rate of MPEs decreased slightly between periods 1 and 2 (from 5.5% to 5.3%), but new types of MPEs appeared. There was a significant decrease in period 3 (to 3.8%; P < .05) and a dramatically significant decrease in period 4 (to 0.7%; P<.0005). Only 3 RVs were found. Interrater agreement (κstatistic) was 0.788 between evaluators. CONCLUSIONS: CPOE implementation decreased prescription errors only to a small extent. However, the addition of a CDSS that limits doses by weight significantly reduced prescription error rates and, most importantly, potential ADEs. This finding emphasizes the major impact of weight-based calculation errors in pediatrics.
KW - Adverse drug events
KW - Clinical decision support
KW - Computer physician order entry
KW - Medication error
KW - Patient safety
KW - Pediatrics
UR - http://www.scopus.com/inward/record.url?scp=70349243901&partnerID=8YFLogxK
U2 - 10.1542/peds.2008-2737
DO - 10.1542/peds.2008-2737
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C2 - 19706588
AN - SCOPUS:70349243901
SN - 0031-4005
VL - 124
SP - 935
EP - 940
JO - Pediatrics
JF - Pediatrics
IS - 3
ER -