Computerized physician order entry can virtually eliminate medication prescribing errors and assure nearly full physician compliance with hospital rules in pediatric critical care units, new research suggests.
In the Jan. 1 issue of Pediatrics, the clinical journal of the American Academy of Pediatrics, researchers from Vanderbilt Children's Hospital in Nashville, Tenn., find that CPOE is a highly effective tool to assure quality of care among critically ill children and adolescents.
Researchers studied 514 patients in a 20-bed pediatric critical care unit at the Vanderbilt facility by reviewing a total of 13,828 medication orders in the two months before and the two months after CPOE was installed and physicians trained on the system.
Prior to CPOE implementation, the PCCU had a rate of 2.2 potential adverse drug events, 30.1 prescribing errors and 6.8 rule violations per 100 orders, according to the study.
But a fully implemented CPOE system "resulted in almost a complete elimination" of prescribing errors and rule violations, to 0.2 and 0.1, respectively, per 100 orders, the study says.
Potential adverse drug events fell by 40.9%, to 1.3 per 100 orders, with CPOE in place.
Potential ADEs involve physicians providing incorrect or inappropriate information or failing to account for patient-specific conditions such as allergies.
Prescribing errors result from incomplete orders or orders in need of further human interpretation before they can be processed, while rule violations are defined as orders that do not follow standard hospital policies.
"Our study demonstrates that a major benefit of CPOE is the enhancement of communication between healthcare professionals that subsequently decreases the possibility of misinterpretation of medication errors," the authors write.
A 1998 study by Harvard patient safety advocates David Bates, M.D., and Lucian Leape, M.D., found that CPOE can reduce serious medication errors by 55% in adult patient populations.
The Vanderbilt research team, led by Neal Patel, M.D., and Frederick Barr, M.D., says that 79% of potential ADEs occur at the time of ordering, but the study does not take into account the fact that actual adverse effects can be prevented at other points in the prescribing process. "CPOE is not the sole solution for preventing potential ADEs," the study says.
For example, the research team says the system did not have full clinical decision support in place, which the team surmises may reduce pediatric dosing and drug interval errors.