Evaluation of medication dose alerts in pediatric inpatients
Corinna Scharnweber1, Brandyn D Lau, Nicole Mollenkopf
1Peter L. Reichertz Institute for Medical Informatics University of Braunschweig, Institute of Technology and Hannover Medical School, Germany. corinna.scharnweber@plri.de
Insights
Computerized provider order entry (CPOE) systems generated over 12,000 dose alerts in pediatric medication ordering. Compliance with these alerts was low, particularly for informational alerts, suggesting a need to refine alert systems and clinical practices.
Area of Science:
- Pediatric pharmacology
- Health informatics
- Clinical decision support systems
Background:
- Computerized provider order entry (CPOE) systems are integral to modern healthcare, aiming to improve medication safety.
- Dose alerts within CPOE systems are designed to prevent medication errors, but their effectiveness can vary.
- Understanding the impact and provider compliance with these alerts is crucial for optimizing their design and utility.
Purpose of the Study:
- To evaluate the impact of 12,093 consecutive dose alerts from a CPOE system on pediatric medication ordering.
- To analyze the compliance rates for different types of alerts (dose range vs. informational).
- To inform future development of more effective CPOE alert systems.
Main Methods:
- Retrospective evaluation of all medication orders and dose alerts at a children's medical and surgical center in 2010.
- Inclusion of hospitalized patients under 21 years old.
- Analysis of dose range alerts and informational alerts, including provider compliance rates.
Main Results:
- Over 182,000 medication orders were analyzed, with 6% generating alerts for over 2000 patients.
- Dose range alerts constituted 73.4% of all alerts, with an 8.5% compliance rate.
- Informational alerts comprised 26.6% of alerts, showing a lower compliance rate of 5.5%.
Conclusions:
- Underdosing alerts appear to offer less value to providers compared to overdosing alerts.
- Low compliance rates necessitate an evaluation of clinical practice and alert thresholds.
- Informational alerts regarding dosing guidelines had minimal impact and should be reconsidered in alert system design.
Objective:
This study evaluates the impact of 12,093 consecutive dose alerts generated by a computerized provider order entry system on pediatric medication ordering.
Patients And Methods:
All medication orders entered and all resulting medication dose alerts at the Johns Hopkins Children's Medical and Surgical Center in 2010, were retrospectively evaluated. Inclusion criteria were hospitalized patients less than 21 years old. There were no exclusion criteria.
Results:
During 2010, there were 7738 admissions for 5553 unique patients. A total of 182,308 medication orders for 1092 unique medications were submitted by providers. Six percent (11,155) of orders or order attempts generated alerts for 2046 patients and 524 medications. Two categories of alerts were analyzed: dose range alerts and informational alerts. 73.4% (8187) of all alerts were dose range alerts, with a compliance rate of 8.5% (694); 26.6% (2968) were informational alerts, with a compliance rate of 5.5% (163).
Conclusions:
We found that underdosing alerts provide less value to providers than overdosing alerts. However, the low compliance with the alerts should trigger the evaluation of clinical practice behavior and the existing alert thresholds. Informational alerts noting the absence of established dosing guidelines had little effect on provider behavior and should be avoided when building a dose range alert system.
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