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Area of Science:

  • Pediatric Intensive Care Medicine
  • Health Informatics
  • Patient Safety

Background:

  • Computerized physician order entry (CPOE) systems are widely adopted in healthcare settings.
  • The long-term impact of CPOE on medication prescription errors requires ongoing evaluation.
  • Pediatric intensive care units (PICUs) present unique challenges for medication management.

Purpose of the Study:

  • To assess the prolonged impact of CPOE on medication prescription errors in a PICU.
  • To evaluate changes in error rates over time since CPOE implementation.
  • To determine the effectiveness of system revisions in mitigating prescription errors.

Main Methods:

  • Observational study in a PICU using CPOE (Metavision) from 2004-2007.
  • Analysis of 2500 electronic prescriptions from 2015 and 2016.
  • Prescription errors classified as potential adverse drug events, medication prescription errors, or rule violations.
  • Comparison of error rates with a 2007 baseline; pharmacist review for inter-rater reliability.

Main Results:

  • Prescription error rate increased from 1.4% in 2007 to 3.2% in 2015.
  • Following clinical decision support system revision, errors decreased to 1% in 2016.
  • Potential adverse drug event rate decreased from 2% (2015) to 0.7% (2016).
  • Medication prescription error rate decreased from 1% (2015) to 0.2% (2016).

Conclusions:

  • Sustained use of CPOE may lead to an increase in prescription errors over time.
  • Regular surveillance and revision of CPOE systems and decision support tools are essential for quality improvement.
  • Proactive strategies are needed to maintain and enhance patient safety in computerized medication ordering systems.