Published online November 1, 2007
PEDIATRICS Vol. 120 No. 5 November 2007, pp. 1058-1066 (doi:10.1542/peds.2006-3160)
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ARTICLE

Impact of Computerized Prescriber Order Entry on the Incidence of Adverse Drug Events in Pediatric Inpatients

Mark T. Holdsworth, PharmD, BCOPa, Richard E. Fichtl, PharmDb, Dennis W. Raisch, PhDc, Adrianne Hewryk, PharmDb, Maryam Behta, PharmDd, Elena Mendez-Rico, PharmDb, Cindy L. Wong, MDe, Jennifer Cohen, MDe, Susan Bostwick, MDe and Bruce M. Greenwald, MDf

a College of Pharmacy, University of New Mexico, Albuquerque, New Mexico
b Department of Pharmacy, New York Presbyterian Hospital, Morgan Stanley Children's Hospital of New York and Komansky Center for Children's Health, New York, New York
c Veterans Affairs Cooperative Studies Program, Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico
d Department of Quality, New York Presbyterian Hospital, New York, New York
e Department of Pediatrics
f Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Medical College of Cornell University, New York, New York

OBJECTIVES. This study was conducted to determine the impact of a computerized physician order entry system with substantial decision support on the incidence and types of adverse drug events in hospitalized children.

METHODS. A prospective methodology was used for the collection of adverse drug events and potential adverse drug events from all patients admitted to the pediatric intensive care and general pediatric units over a 6-month period. Data from a previous adverse drug event study of the same patient care units before computerized physician order entry implementation were used for comparison purposes.

RESULTS. Data for 1197 admissions before the introduction of computerized physician order entry were compared with 1210 admissions collected after computerized physician order entry implementation. After computerized physician order entry implementation, it was observed that the number of preventable adverse drug events (46 vs 26) and potential adverse drug events (94 vs 35) was reduced. Reductions in overall errors, dispensing errors, and drug-choice errors were associated with computerized physician order entry. There were reductions in significant events, as well as those events rated as serious or life threatening, after the implementation of computerized physician order entry. Some types of adverse drug events continued to persist, specifically underdosing of analgesics. There were no differences in length of stay or patient disposition between preventable adverse drug events and potential adverse drug events in either study period.

CONCLUSIONS. This study demonstrated that a computerized physician order entry system with substantive decision support was associated with a reduction in both adverse drug events and potential adverse drug events in the inpatient pediatric population. Additional system refinements will be necessary to affect remaining adverse drug events. Preventable events did not predict excess length of stay and instead may represent a sign, rather than a cause, of more complicated illness.

Key Words: adverse events • children • computers

Abbreviations: ADE—adverse drug event • CPOE—computerized prescriber order entry • CMI—case-mix index • PDT—pediatric dosing table • RR—relative risk • OR—odds ratio • CI—confidence interval • LOS—length of stay

Accepted May 29, 2007.