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The effect of computerized physician order entry on medication errors and adverse drug events in pediatric inpatients
W James King1, Naomi Paice, Jagadish Rangrej
1Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. king@cheo.on.ca
Insights
Computerized physician order entry (CPOE) significantly reduced medication errors in pediatric inpatients. However, the study found no significant impact on adverse drug events (ADEs) after CPOE implementation.
Area of Science:
- Health Informatics
- Pediatric Patient Safety
- Medication Error Reduction
Background:
- Medication errors pose a significant risk to patient safety, particularly in pediatric populations.
- Computerized physician order entry (CPOE) systems are designed to mitigate these risks by improving the accuracy and legibility of medical orders.
- Assessing the real-world impact of CPOE on medication errors and adverse drug events (ADEs) is crucial for optimizing healthcare delivery.
Purpose of the Study:
- To evaluate the effectiveness of a commercially available CPOE system in reducing medication errors and ADEs among pediatric inpatients.
- To compare medication error rates and ADEs in wards utilizing CPOE versus those relying on handwritten orders.
Main Methods:
- A retrospective cohort study was conducted at a tertiary care pediatric hospital.
- Data were collected from pediatric inpatients across medical and surgical wards over a 6-year period.
- Medication error rates and ADEs were compared before and after the implementation of CPOE on specific wards.
Main Results:
- The overall medication error rate (MER) was 4.49 per 1000 patient days.
- Following CPOE implementation, MER decreased by 40% on intervention wards compared to control wards (ratio = 0.60).
- No significant reduction in ADEs was observed with CPOE implementation (ratio of rate ratios = 1.30).
Conclusions:
- The introduction of a CPOE system was associated with a significant decrease in medication errors in pediatric inpatients.
- CPOE did not demonstrate a significant impact on reducing adverse drug events in this patient population.
- Further research may be needed to explore strategies for optimizing CPOE to also reduce ADEs.
Objective:
Computerized physician order entry (CPOE) has the potential to reduce patient injury resulting from medication errors. We assessed the impact of a CPOE system on medication errors and adverse drug events (ADEs) in pediatric inpatients.
Design:
A retrospective cohort study.
Setting:
Tertiary care pediatric hospital.
Participants:
Pediatric inpatients on 3 medical and 2 surgical wards.
Intervention:
CPOE system implemented on 2 medical wards and compared with 1 medical and 2 surgical wards that continued to use hand written orders.
Outcome Measures:
Rate of medication error and ADEs before and after CPOE implementation.
Results:
In 6 years, a total of 804 medication errors were identified with 18 ADEs, resulting in patient injury among 36 103 discharges and 179 183 patient days. The overall medication error rate (MER) was 4.49 per 1000 patient days. Before the introduction of CPOE, the MERs of the intervention versus control wards were indistinguishable (ratio = 0.93; 95% confidence interval [CI] = 0.76, 1.13). After the introduction of CPOE, the MER was 40% lower on the intervention than on the control wards (ratio = 0.60; 95% CI = 0.48, 0.74). On average, 490 patient days are required to see the benefit of one less medication error using CPOE. We did not demonstrate a similar effect of CPOE for ADEs (ratio of rate ratios = 1.30; 95% CI 0.47, 3.52).
Conclusions:
The introduction of a commercially available physician computer order entry system was associated with a significant decrease in the rate of medication errors but not ADEs in an inpatient pediatric population.