The effect of a decision support system on the incidence of prescription errors in a PICU

Hashemi, Fatema; Gelder, Thomas G. van; Bollen, Casper W.; Liem, Y; Egberts, Toine C. G.

doi:10.1111/jcpt.13562

Cited by 14 publications

(19 citation statements)

References 30 publications

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“…The fact that handwritten prescriptions contained more errors than electronic prescriptions is a plausible nding, as CPOE leads to standardized, legible, and complete prescriptions [31].…”

Section: Discussionmentioning

confidence: 99%

Prescribing errors in children: What is the impact of a computerized physician order entry?

Satir

Pfiffner

Meier

et al. 2022

Preprint

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Purpose: Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children’s Hospital Zurich. Methods: We performed medication review on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index) as well as the interrater reliability (Cohen’s Kappa) were analyzed. Results: CPOE significantly reduced the rate of errors from 25 errors / 100 prescriptions (95% CI: 23 – 27) to 16 errors / 100 prescriptions (95% CI 14 – 18). Particularly the prescribing quality was improved by reducing PCNE error 5.2 “lacking information” (e.g. lacking drug form or maximum possible number of doses for reserve medication). Medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not statistically significantly altered after introduction of the CPOE. Overall severity of errors was reduced. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusions: The CPOE increases patient safety by reducing the rate and severity of prescribing errors. The reason for the observed increase in medication reconciliation problems might be the hybrid-system with remaining paper-prescriptions for special medication. The lacking effect on dosing errors might be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions on how to increase the usability of the CPOE, and full integration of CDS tools such as automated dose check into the CPOE.

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“…The fact that handwritten prescriptions contained more errors than electronic prescriptions is a plausible nding, as CPOE leads to standardized, legible, and complete prescriptions [31].…”

Section: Discussionmentioning

confidence: 99%

Prescribing errors in children: What is the impact of a computerized physician order entry?

Satir

Pfiffner

Meier

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…In other settings it has previously been shown that CDSS can decrease prescribing errors and wrong doses in children [ 27 , 28 ]. Little is known about the effects of using a CDSS for this population in community pharmacies.…”

Section: Discussionmentioning

confidence: 99%

“…Community pharmacists have an important role in preventing DRPs in pediatric patients [ 24 ], but studies indicate that more training or better support is needed for pharmacists to be able to detect and prevent errors in this population [ 25 , 26 ]. Furthermore, there is limited knowledge about CDSS to prevent DRPs in pediatric patients in the community pharmacy setting [ 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

Potential Drug-Related Problems in Pediatric Patients—Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden

2023

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The clinical support system Electronic Expert Support (EES) is available at all pharmacies in Sweden to examine electronic prescriptions when dispensing to prevent drug-related problems (DRPs). DRPs are common, and result in patient suffering and substantial costs for society. The aim of this research was to study the use of EES for the pediatric population (ages 0–12 years), by describing what types of alerts are generated for potential DRPs, how they are handled, and how the use of EES has changed over time. Data on the number and categories of EES analyses, alerts, and resolved alerts were provided by the Swedish eHealth Agency. The study shows that the use of EES has increased. The most common type of alert for a potential DRP among pediatric patients was regarding high doses in children (30.3% of all alerts generated). The most common type of alert for a potential DRP that was resolved among pediatrics was therapy duplication (4.6% of the alerts were resolved). The most common reason for closing an alert was dialogue with patient for verification of the treatment (66.3% of all closed alerts). Knowledge of which type of alerts are the most common may contribute to increased prescriber awareness of important potential DRPs.

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“…The lacking effect of CPOE on dosing errors was also seen by Roumeliotis et al [ 28 ]. Dosing errors could be prevented more effectively by a fully integrated CDS that offers dosing support and automated dose check [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Prescribing errors in children: what is the impact of a computerized physician order entry?

et al. 2023

View full text Add to dashboard Cite

Prescribing errors represent a safety risk for hospitalized patients, especially in pediatrics. Computerized physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on pediatric general wards. This study investigated the impact of a CPOE on prescribing errors in children on general wards at the University Children’s Hospital Zurich. We performed medication reviews on a total of 1000 patients before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index), as well as the interrater reliability (Cohen’s kappa), were analyzed. Potentially harmful errors were significantly reduced from 18 errors/100 prescriptions (95% CI: 17–20) to 11 errors/100 prescriptions (95% CI: 9–12) after CPOE implementation. A large number of errors with low potential for harm (e.g., “missing information”) was reduced after the introduction of the CPOE, and consequently, the overall severity of potential harm increased post-CPOE. Despite general error rate reduction, medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, significantly increased after the introduction of the CPOE. The most common pediatric prescribing errors, the dosing errors (PCNE errors 3), were not altered on a statistically significant level after the introduction of the CPOE. Interrater reliability showed moderate agreement (Κ = 0.48). Conclusion: Patient safety increased by reducing the rate of prescribing errors after CPOE implementation. The reason for the observed increase in medication reconciliation problems might be the hybrid system with remaining paper prescriptions for special medication. The lacking effect on dosing errors could be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before the implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions to increase the usability of the CPOE, and full integration of CDS tools such as automated dose checks into the CPOE. What is Known: • Prescribing errors, especially dosing errors, are a common safety threat for pediatric inpatients. •The introduction of a CPOE may reduce prescribing errors, though pediatric general wards are poorly studied. What is New: •To our knowledge, this is the first study on prescribing errors in pediatric general wards in Switzerland investigating the impact of a CPOE. •We found that the overall error rate was significantly reduced after the implementation of the CPOE. The severity of potential harm was higher in the post-CPOE period, which implies that low-severity errors were substantially reduced after CPOE implementation. Dosing errors were not reduced, but missing information errors and drug selection errors were reduced. On the other hand, medication reconciliation problems increased.

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The effect of a decision support system on the incidence of prescription errors in a PICU

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri butio n-NonCo mmerc ial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 14 publications

References 30 publications

Prescribing errors in children: What is the impact of a computerized physician order entry?

Prescribing errors in children: What is the impact of a computerized physician order entry?

Potential Drug-Related Problems in Pediatric Patients—Describing the Use of a Clinical Decision Support System at Pharmacies in Sweden

Prescribing errors in children: what is the impact of a computerized physician order entry?

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