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PEDIATRICS Vol. 112 No. 3 September 2003, pp. 506-509

The Effect of Computerized Physician Order Entry on Medication Errors and Adverse Drug Events in Pediatric Inpatients

W. James King, MSc, MD*,{ddagger}, Naomi Paice, MD*, Jagadish Rangrej, MMath{ddagger},§, Gregory J. Forestell, MHA|| and Ron Swartz, BScPharm

* Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
{ddagger} Children’s Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
§ Chalmers Research Group, University of Ottawa, Ottawa, Ontario, Canada
|| Management Information Services Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
Pharmacy Department, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada

Objective. Computerized physician order entry (CPOE) has the potential to reduce patient injury resulting from medication errors. We assessed the impact of a CPOE system on medication errors and adverse drug events (ADEs) in pediatric inpatients.

Design. A retrospective cohort study.

Setting. Tertiary care pediatric hospital.

Participants. Pediatric inpatients on 3 medical and 2 surgical wards.

Intervention. CPOE system implemented on 2 medical wards and compared with 1 medical and 2 surgical wards that continued to use hand written orders.

Outcome Measures. Rate of medication error and ADEs before and after CPOE implementation.

Results. In 6 years, a total of 804 medication errors were identified with 18 ADEs, resulting in patient injury among 36 103 discharges and 179 183 patient days. The overall medication error rate (MER) was 4.49 per 1000 patient days. Before the introduction of CPOE, the MERs of the intervention versus control wards were indistinguishable (ratio = 0.93; 95% confidence interval [CI] = 0.76, 1.13). After the introduction of CPOE, the MER was 40% lower on the intervention than on the control wards (ratio = 0.60; 95% CI = 0.48, 0.74). On average, 490 patient days are required to see the benefit of one less medication error using CPOE. We did not demonstrate a similar effect of CPOE for ADEs (ratio of rate ratios = 1.30; 95% CI 0.47, 3.52).

Conclusions. The introduction of a commercially available physician computer order entry system was associated with a significant decrease in the rate of medication errors but not ADEs in an inpatient pediatric population.

Key Words: computerized physician order entry • inpatients • medication error • injury

Abbreviations: ADE, adverse drug event • MER, medication error rate • CPOE, computerized physician order entry • CHEO, Children’s Hospital of Eastern Ontario • NNT, number needed to treat • CI, confidence interval

Received for publication Dec 10, 2002; Accepted Feb 21, 2003.


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