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Improving medication safety in a paediatric hospital: a mixed-methods evaluation of a newly implemented computerised
Man Qing Liang1,2, Maxime Thibault2,3, Philippe Jouvet1,2
1Department of Management, Evaluation and Health Policy, School of Public Health, Université de Montréal, Montréal, Québec, Canada.
Insights
Implementing a paediatric Computerised Provider Order Entry (CPOE) system reduced medication errors, particularly in order acknowledgement and transcription. Further improvements in electronic medication administration records can enhance paediatric patient safety.
Area of Science:
- Health Informatics
- Patient Safety
- Pediatric Care
Background:
- Computerised Provider Order Entry (CPOE) systems aim to decrease medication errors in healthcare settings.
- Challenges exist in CPOE implementation, especially within pediatric environments.
- Previous studies highlight difficulties in achieving error reduction goals with CPOE.
Purpose of the Study:
- To evaluate the impact of a pediatric CPOE system on medication safety.
- To identify strategies for preventing medication errors in pediatric settings.
Main Methods:
- A pre-post observational study utilizing mixed methods was conducted at a pediatric academic health center.
- Medication management workflows and CPOE implementation were analyzed through direct involvement, observation, and document review.
- Incident reports were used to compare error rates and types before and after CPOE implementation.
Main Results:
- The overall medication error rate decreased post-CPOE implementation, though not statistically significantly.
- Significant reductions in errors were observed during order acknowledgement, transmission, and transcription.
- Most errors occurred during medication administration, with few at the prescription stage.
- The CPOE system introduced some technology-related errors, but also had the potential to prevent pre-existing errors.
Conclusions:
- CPOE adoption has both positive and negative effects on the medication management workflow.
- Simplifying order acknowledgement, transmission, and transcription via CPOE is crucial for reducing medication errors.
- Enhancing the usability of electronic medication administration records is recommended to further improve pediatric medication safety.
Objectives:
Computerised provider order entry (CPOE) systems have been implemented around the world as a solution to reduce ordering and transcription errors. However, previous literature documented many challenges to attain this goal, especially in paediatric settings. The objectives of this study were to (1) analyse the impact of a paediatric CPOE system on medication safety and (2) suggest potential error prevention strategies.
Methods:
A pre-post observational study was conducted at the pilot ward (n=60 beds) of a paediatric academic health centre through mixed methods. The implementation project and medication management workflows were described through active participation to the project management team, observation, discussions and analysis of related documents. Furthermore, using incident reports, the nature of each error and error rate was compared between the preperiod and postperiod.
Results:
The global error rate was lower, but non-statistically significant, in the post implementation phase, which was mostly driven by a significant reduction in errors during order acknowledgement, transmission and transcription. Few errors occurred at the prescription step, and most errors occurred during medication administration. Furthermore, some errors could have been prevented using a CPOE in the pre-implementation period, and the CPOE led to few technology-related errors.
Discussion And Conclusion:
This study identified both intended and unintended effects of CPOE adoption through the entire medication management workflow. This study revealed the importance of simplifying the acknowledgement, transmission and transcribing steps through the implementation of a CPOE to reduce medication errors. Improving the usability of the electronic medication administration record could help further improve medication safety.
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