Response to medication dosing alerts for pediatric inpatients using a computerized provider order entry system

Area of Science:

• Pediatric patient safety
• Health informatics
• Medication error reduction

Background:

• Medication dosing errors pose significant risks to hospitalized children.
• Computerized provider order entry (CPOE) systems with clinical decision support (CDS) can mitigate medication errors.
• Understanding provider responses to CDS alerts is crucial for optimizing patient safety.

Purpose of the Study:

• To evaluate how clinicians respond to medication dosing alerts within a CPOE system.
• To identify variations in alert response based on clinician specialty for pediatric inpatients.

Main Methods:

• Retrospective analysis of medication dosing alerts over one year (2008) for pediatric inpatients.
• Categorization of alerts by medication dosing, prescriber specialty, and prescriber action (accepted, overridden, cancelled).

Main Results:

• 1,024 dosing alerts were triggered from 18,163 medication orders.
• Overdosing alerts constituted 91% of all alerts.
• Pediatric-trained providers overrode more alerts and cancelled fewer orders than non-pediatric-trained providers (p<0.001).

Conclusions:

• Significant differences exist in how pediatric-trained and non-pediatric-trained providers respond to CDS alerts.
• Both provider groups modified orders similarly based on CDS recommendations.
• CPOE with CDS is particularly valuable in pediatric care settings with diverse provider specialties.