Implementation of a Computerized Provider Order Entry System in a Pediatric Hospital in Canada

Area of Science:

• Health Informatics
• Pediatric Pharmacy
• Patient Safety

Background:

• The Centre Hospitalier Universitaire Sainte-Justine implemented a commercial computerized provider order entry (CPOE) system in October 2019.
• Pediatric academic tertiary hospitals face unique challenges in medication management.

Purpose of the Study:

• To evaluate the impact of CPOE implementation on medication errors.
• To identify system design and configuration vulnerabilities in a pediatric CPOE.

Main Methods:

• A pre-post implementation study design was employed.
• Medication errors were systematically captured and analyzed by clinical pharmacists.
• Vulnerability analysis used typical clinical order test cases in an inpatient pediatric setting.

Main Results:

• CPOE implementation eliminated prescription conformity and legibility errors.
• Pharmacists continued to identify and intervene in medication errors, particularly inappropriate dosing instructions.
• System vulnerability analysis underscored the need for optimized clinical decision support for pediatric dosing.

Conclusions:

• CPOE systems can substantially improve medication safety by reducing certain error types.
• Ongoing vigilance and specific system configuration are crucial for pediatric patient safety.
• Clinical decision support systems require tailored design to effectively manage pediatric dosing complexities.