Computerized order entry with limited decision support to prevent prescription errors in a PICU

Area of Science:

• Pediatric critical care medicine
• Health informatics
• Patient safety

Background:

• Prescription errors pose a significant risk in pediatric care.
• The effectiveness of computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) in reducing these errors remains unclear.

Purpose of the Study:

• To evaluate the impact of CPOE and a weight-based dosing CDSS on prescription error rates in a pediatric intensive care unit (PICU).

Main Methods:

• A review of 5000 medication orders across four periods: pre-CPOE, post-CPOE, post-CDSS implementation, and post-prescription authorization changes.
• Errors were categorized into potential adverse drug events (ADEs), medication prescription errors (MPEs), and rule violations (RVs).

Main Results:

• CPOE alone showed a minimal reduction in potential ADEs and MPEs.
• The introduction of a weight-based dosing CDSS significantly decreased potential ADEs (from 2.5% to 0.8%) and MPEs (from 5.5% to 3.8%).
• Further significant reductions were observed after changes in prescription authorization.

Conclusions:

• CPOE implementation had a limited effect on reducing prescription errors.
• A CDSS incorporating weight-based dosing is highly effective in reducing pediatric prescription errors and potential ADEs.
• Weight-based calculation errors are a critical factor contributing to adverse events in pediatric medication prescribing.