Risk Factors for Electronic Prescription Errors in Pediatric Intensive Care Patients

Gili Kadmon*, Michal Shifrin, Michal Pinchover, Elhanan Nahum

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objectives: To assess risk factors for electronic prescription errors in a PICU. Design: A database of electronic prescriptions issued by a computerized physician order entry with clinical decision support system was analyzed to identify risk factors for prescription errors. Measurements and Main Results: Of 6,250 prescriptions, 101 were associated with errors (1.6%). The error rate was twice as high in patients older than 12 years than in patients children 6-12 and 0-6 years old (2.4% vs 1.3% and 1.2%, respectively, p < 0.05). Compared with patients without errors, patients with errors had a significantly higher score on the Pediatric Index of Mortality 2 (-3.7 vs-4.5; p = 0.05), longer PICU stay (6 vs 3.1 d; p < 0.0001), and higher number of prescriptions per patient (40.8 vs. 15.7; p < 0.0001). In addition, patients with errors were more likely to have a neurologic main admission diagnosis (p = 0.008) and less likely to have a cardiologic diagnosis (p = 0.03) than patients without errors. Conclusions: Our findings suggest that older patient age and greater disease severity are risk factors for electronic prescription errors.

Original languageEnglish
Pages (from-to)557-562
Number of pages6
JournalPediatric Critical Care Medicine
Issue number6
StatePublished - 1 Jun 2020
Externally publishedYes


  • adverse drug event
  • clinical decision support system
  • computerized physician order entry
  • medication error
  • patient safety


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