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The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital
Jeffrey S Upperman1, Patricia Staley, Kerri Friend
1Division of Pediatric Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA. jeffrey.upperman@chp.edu
Insights
Hospitalwide computerized physician order entry (CPOE) significantly reduced harmful medication errors in a pediatric hospital, enhancing patient safety. This system also automates healthcare quality monitoring and improvement.
Area of Science:
- Pediatric Health Informatics
- Patient Safety Research
- Clinical Pharmacy
Background:
- Medication errors are a major cause of morbidity and increased healthcare costs in pediatric settings.
- Computerized Physician Order Entry (CPOE) systems are increasingly adopted to mitigate these risks.
Purpose of the Study:
- To evaluate the impact of hospitalwide CPOE implementation on medication errors in a pediatric hospital.
- To test the hypothesis that CPOE reduces medication errors and improves patient safety.
Main Methods:
- Retrospective and prospective analysis of inpatient discharge and adverse drug event (ADE) data.
- Comparison of ADE rates before and after CPOE implementation using statistical tests.
- Calculation of the Number Needed to Treat (NNT) to quantify the intervention's effectiveness.
Main Results:
- Post-CPOE, verbal order compliance increased from 80% to 95%, and transcription errors were eliminated.
- While overall ADEs showed no significant change (0.3 vs. 0.37 per 1000 doses, P=.3), harmful ADEs decreased significantly (0.05 vs. 0.03 per 1000 doses, P=.05).
- CPOE implementation demonstrated a potential to prevent 1 ADE every 64 patient days.
Conclusions:
- Hospitalwide CPOE implementation effectively reduces harmful ADEs in pediatric care, thereby enhancing patient safety.
- CPOE systems offer an automated approach for continuous monitoring and quality improvement in healthcare delivery.
Purpose:
Medication errors contribute significantly to the morbidity and costs of pediatric health care. The authors hypothesized that hospitalwide computerized physician order entry (CPOE) in a pediatric hospital would lead to a decrease in medication errors.
Methods:
The authors retrospectively evaluated and prospectively analyzed inpatient discharge and usage and adverse drug event (ADE) rate data pre- and postintroduction of a hospitalwide implementation of CPOE in a tertiary care pediatric hospital. They compared pre- and postintervention ADEs (Student's t test) and computed the number needed to treat (NNT) analog.
Results:
Over the 9-month study period, there were 45,615 in patient days and 8619 discharges. Pre-CPOE verbal order regulatory compliance was 80%, whereas post-CPOE increased to 95%. Transcription errors were eliminated. All ADEs pre-CPOE were 0.3 +/- 0.04 per 1000 doses, whereas post-CPOE ADEs were 0.37 +/- 0.05 per 1000 doses (P = .3). Harmful ADEs pre-CPOE were 0.05 +/- 0.017 per 1000 doses, while post-CPOE ADEs were 0.03 +/- 0.003 per 1000 doses (P = .05). Our NNT data demonstrate that CPOE would prevent 1 ADE every 64 (95% CI 25-100) patient days.
Conclusions:
CPOE decreases harmful ADEs in a pediatric hospital, thus leading to increased patient safety. In addition, CPOE provides an automated system for monitoring and improving health care quality.
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