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PEDIATRICS Vol. 113 No. 1 January 2004, pp. 59-63

Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit

Amy L. Potts, PharmD*, Frederick E. Barr, MD, MSCI{ddagger}, David F. Gregory, PharmD, BCPS*, Lorianne Wright, PharmD* and Neal R. Patel, MD, MPH{ddagger},§

* Department of Pharmaceutical Services, Vanderbilt Children’s Hospital, Nashville, Tennessee
{ddagger} Division of Pediatric Critical Care and Anesthesia, Department of Pediatrics, Vanderbilt Children’s Hospital, Nashville, Tennessee
§ Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee

Objective. Medication errors are a major concern of health care professionals and medical institutions, especially errors involving children. Studies in adults have shown that computerized physician order entry (CPOE) systems reduce medication errors and adverse drug events (ADEs). The effect of CPOE implementation in a pediatric population has not been reported. The objective of this study was to evaluate the impact of CPOE on the frequency of errors in the medication ordering process in a pediatric critical care unit (PCCU).

Methods. A prospective trial was conducted of 514 pediatric patients who were admitted to a 20-bed PCCU in a tertiary-care children’s hospital before and after implementation of CPOE. Medication errors were identified after review of all orders during the study period and then further classified as potential ADEs, medication prescribing errors (MPE), and rule violations (RV).

Results. A total of 13 828 medication orders were reviewed. Before implementation, potential ADEs occurred at a rate of 2.2 per 100 orders, MPEs at a rate of 30.1 per 100 orders, and RVs at a rate of 6.8 per 100 orders. After implementation, the rate of potential ADEs was reduced to 1.3 per 100 orders, MPEs to 0.2 per 100 orders, and RVs to 0.1 per 100 orders. The overall error reduction was 95.9%. Potential ADEs were reduced by 40.9%, and MPEs and RVs were reduced by 99.4% and 97.9%, respectively.

Conclusions. The implementation of CPOE resulted in almost a complete elimination of MPEs and RVs and a significant but less dramatic effect on potential ADEs.

Key Words: medication errors • critical care • pediatrics • clinical decision support systems; computer-assisted drug therapy

Abbreviations: ADE, adverse drug event • CPOE, computerized physician order entry • IOM, Institute of Medicine • PCCU, pediatric critical care unit • MPE, medication prescribing error • RV, rules violation

Received for publication Oct 28, 2002; Accepted Apr 8, 2003.




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