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

Holdsworth, Mark T.; Fichtl, Richard E.; Raisch, Dennis W.; Hewryk, Adrianne; Behta, Maryam; Mendez-Rico, Elena; Wong, Cindy L.; Cohen, Jennifer; Bostwick, Susan; Greenwald, Bruce M.

doi:10.1542/peds.2006-3160

Cited by 99 publications

(110 citation statements)

References 31 publications

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“…Of the studies reporting preventable ADEs, 1,40,45,62,66,73 2 studies 1,45 reported statistically significant decreases in ADEs after an intervention: a 77% reduction in preventable ADE prescribing errors using multiple error reduction strategies (n = 16 of 12 026 pre versus 3 of 9187 post) and a 43% reduction in all types of preventable ADE errors using CPOE with CDS (n = 46 of 1197 pre versus 26 of 1210 post), respectively. Two of the other studies 40,66 reported only 1 preventable ADE during their respective pre-and postintervention periods, and a third study 62 reported 2 preventable ADEs, 1 during the pre-and 1 during the postintervention periods.…”

Section: Aggregate Data Synthesismentioning

confidence: 99%

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Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Rinke

Bundy

Velasquez³

et al. 2014

Pediatrics

129

119

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BACKGROUND AND OBJECTIVE: Medication errors cause appreciable morbidity and mortality in children. The objective was to determine the effectiveness of interventions to reduce pediatric medication errors, identify gaps in the literature, and perform meta-analyses on comparable studies. METHODS:Relevant studies were identified from searches of PubMed, Embase, Scopus, Web of Science, the Cochrane Library, and the Cumulative Index to Nursing Allied Health Literature and previous systematic reviews. Inclusion criteria were peer-reviewed original data in any language testing an intervention to reduce medication errors in children. Abstract and full-text article review were conducted by 2 independent authors with sequential data extraction.RESULTS: A total of 274 full-text articles were reviewed and 63 were included. Only 1% of studies were conducted at community hospitals, 11% were conducted in ambulatory populations, 10% reported preventable adverse drug events, 10% examined administering errors, 3% examined dispensing errors, and none reported cost-effectiveness data, suggesting persistent research gaps. Variation existed in the methods, definitions, outcomes, and rate denominators for all studies; and many showed an appreciable risk of bias. Although 26 studies (41%) involved computerized provider order entry, a meta-analysis was not performed because of methodologic heterogeneity. Studies of computerized provider order entry with clinical decision support compared with studies without clinical decision support reported a 36% to 87% reduction in prescribing errors; studies of preprinted order sheets revealed a 27% to 82% reduction in prescribing errors.CONCLUSIONS: Pediatric medication errors can be reduced, although our understanding of optimal interventions remains hampered. Research should focus on understudied areas, use standardized definitions and outcomes, and evaluate cost-effectiveness. Pediatrics

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Section: Aggregate Data Synthesismentioning

confidence: 99%

“…Five studies examined the effect of CPOE with CDS for multiple medications on inpatients 45,46,51,73,88 and found a 14% increase in errors to a 99% decrease in all types of errors. The study reporting a 14% increase in all types medication errors 73 noted that this change was non-statistically significant (P .…”

Section: Data Synthesis For Specific Interventionsmentioning

confidence: 99%

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Rinke

Bundy

Velasquez³

et al. 2014

Pediatrics

129

119

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“…Electronic medication prescribing and atuomated dose checking [36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Computerized physician order entry (n = 5)…”

Section: Intervention Type Example Of Intervention Referencesmentioning

confidence: 99%

Interventions to reduce medication errors in neonatal care: a systematic review

Nguyen

Mosel

Grzeskowiak

2017

Therapeutic Advances in Drug Safety

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Background: Medication errors represent a significant but often preventable cause of morbidity and mortality in neonates. The objective of this systematic review was to determine the effectiveness of interventions to reduce neonatal medication errors. Methods: A systematic review was undertaken of all comparative and noncomparative studies published in any language, identified from searches of PubMed and EMBASE and referencelist checking. Eligible studies were those investigating the impact of any medication safety interventions aimed at reducing medication errors in neonates in the hospital setting. Results: A total of 102 studies were identified that met the inclusion criteria, including 86 comparative and 16 noncomparative studies. Medication safety interventions were classified into six themes: technology (n = 38; e.g. electronic prescribing), organizational (n = 16; e.g. guidelines, policies, and procedures), personnel (n = 13; e.g. staff education), pharmacy (n = 9; e.g. clinical pharmacy service), hazard and risk analysis (n = 8; e.g. error detection tools), and multifactorial (n = 18; e.g. any combination of previous interventions). Significant variability was evident across all included studies, with differences in intervention strategies, trial methods, types of medication errors evaluated, and how medication errors were identified and evaluated. Most studies demonstrated an appreciable risk of bias. The vast majority of studies (>90%) demonstrated a reduction in medication errors. A similar median reduction of 50-70% in medication errors was evident across studies included within each of the identified themes, but findings varied considerably from a 16% increase in medication errors to a 100% reduction in medication errors. Conclusion: While neonatal medication errors can be reduced through multiple interventions aimed at improving the medication use process, no single intervention appeared clearly superior. Further research is required to evaluate the relative cost-effectiveness of the various medication safety interventions to facilitate decisions regarding uptake and implementation into clinical practice.

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“…While this information suggests that national organizations encourage CPOE adoption and use of CPOE in children's hospitals is not entirely uncommon, higher levels of use among hospitals that care for children will likely be needed to achieve the IOM goals of redesigning our healthcare system. Current research focused on CPOE use in hospitals that care for children has demonstrated improvements in safety of care with an overall reduction in medication errors [7][8][9][10]. While improvements in medical errors are almost uniformly found with the use of CPOE, the improvement in costly adverse drug events was only found in one of the studies.…”

Section: Introductionmentioning

confidence: 99%

“…While improvements in medical errors are almost uniformly found with the use of CPOE, the improvement in costly adverse drug events was only found in one of the studies. [8] Nonetheless, improvements in medication administration represent a very important opportunity in pediatrics because children are at high risk of medication errors because medications are often delivered with weightbased prescribing and frequently used off-label, resulting in a greater potential for error [11]. Despite this opportunity for medical safety, Han et al published a study in 2005 that demonstrated an association between CPOE use in a Pediatric Intensive Care Unit with an increase in patient mortality [12].…”

Section: Introductionmentioning

confidence: 99%

Is Computerized Physician Order Entry Use Associated with a Decrease in Hospital Resource Utilization in Hospitals That Care for Children?

2011

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Despite large hospital costs for implementation and maintenance of Computerized Physician Order Entry (CPOE) for medication safety, little evidence exists to determine if predicted efficiency improvements translate into lower hospital resource utilization for inpatient pediatrics. The purpose of this study is to investigate the relationship between hospital CPOE use and resource utilization per case within children's healthcare. The authors use a retrospective cross-sectional design with linear regression to assess relationships between hospital CPOE use and resource utilization per case. Despite large CPOE costs and financial barriers to adoption, we find that compared to those without CPOE, hospitals with CPOE did not have significantly lower cost per case. Because of the lack of evidence for financial benefit for CPOE use hospitals will likely need other motives to adopt CPOE. This emphasizes the importance of financial incentives for adoption of CPOE within children's healthcare and represents important benchmark data for future comparison.

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

Cited by 99 publications

References 31 publications

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Interventions to Reduce Pediatric Medication Errors: A Systematic Review

Interventions to reduce medication errors in neonatal care: a systematic review

Is Computerized Physician Order Entry Use Associated with a Decrease in Hospital Resource Utilization in Hospitals That Care for Children?

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