Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e421-e427 (doi:10.1542/peds.2007-0220)

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Walsh, K. E. Articles by Bauchner, H. Search for Related Content PubMed PubMed Citation Articles by Walsh, K. E. Articles by Bauchner, H. Related Collections Office Practice Social Bookmarking                         What's this?

ARTICLE

Effect of Computer Order Entry on Prevention of Serious Medication Errors in Hospitalized Children

Kathleen E. Walsh, MD^a,b, Christopher P. Landrigan, MD^c, William G. Adams, MD^b, Robert J. Vinci, MD^b, John B. Chessare, MD^b,d, Maureen R. Cooper, RN^b, Pamela M. Hebert, RN^b, Elisabeth G. Schainker, MD^b,e, Thomas J. McLaughlin, ScD^a,f and Howard Bauchner, MD^b

^a Departments of Pediatrics
^f Psychiatry, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, Massachusetts
^b Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, Massachusetts
^c Departments of Medicine, Brigham and Women's Hospital and Children's Hospital Boston, Boston, Massachusetts
^d Norwood Caritas Hospital, Norwood, Massachusetts
^e Department of Pediatrics, Tufts University School of Medicine/New England Medical Center, Boston, Massachusetts

OBJECTIVE. Although initial research suggests that computerized physician order entry reduces pediatric medication errors, no comprehensive error surveillance studies have evaluated the effect of computerized physician order entry on children. Our objective was to evaluate comprehensively the effect of computerized physician order entry on the rate of inpatient pediatric medication errors.

METHODS. Using interrupted time-series regression analysis, we reviewed all charts, orders, and incident reports for 40 admissions per month to the NICU, PICU, and inpatient pediatric wards for 7 months before and 9 months after implementation of commercial computerized physician order entry in a general hospital. Nurse data extractors, who were unaware of study objectives, used an established error surveillance method to detect possible errors. Two physicians who were unaware of when the possible error occurred rated each possible error.

RESULTS. In 627 pediatric admissions, with 12 672 medication orders written over 3234 patient-days, 156 medication errors were detected, including 70 nonintercepted serious medication errors (22/1000 patient-days). Twenty-three errors resulted in patient injury (7/1000 patient-days). In time-series analysis, there was a 7% decrease in level of the rates of nonintercepted serious medication errors. There was no change in the rate of injuries as a result of error after computerized physician order entry implementation.

CONCLUSIONS. The rate of nonintercepted serious medication errors in this pediatric population was reduced by 7% after the introduction of a commercial computerized physician order entry system, much less than previously reported for adults, and there was no change in the rate of injuries as a result of error. Several human-machine interface problems, particularly surrounding selection and dosing of pediatric medications, were identified. Additional refinements could lead to greater effects on error rates.

---

Key Words: patient safety • medication errors • medical errors • computer order entry • quality improvement

Abbreviations: CPOE—computerized physician order entry • CI—confidence interval • IRR—incidence rate ratio

---

Accepted Jul 21, 2007.

CiteULike    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. Duckers, M. Faber, J. Cruijsberg, R. Grol, L. Schoonhoven, and M. Wensing Safety and Risk Management Interventions in Hospitals: A Systematic Review of the Literature Med Care Res Rev, December 1, 2009; 66(6_suppl): 90S - 119S. [Abstract] [PDF]

				K. E. Walsh, K. S. Dodd, K. Seetharaman, D. W. Roblin, L. J. Herrinton, A. Von Worley, G. Naheed Usmani, D. Baer, and J. H. Gurwitz Medication Errors Among Adults and Children With Cancer in the Outpatient Setting J. Clin. Oncol., February 20, 2009; 27(6): 891 - 896. [Abstract] [Full Text] [PDF]

				K. E Walsh and J. H Gurwitz Medical abbreviations: writing little and communicating less Arch. Dis. Child., October 1, 2008; 93(10): 816 - 817. [Full Text] [PDF]