Summary
Objective: Medication dosing errors are of particular concern in hospitalized children. Avoidance
of such errors is essential to quality improvement and patient safety. Computerized
provider order entry (CPOE) systems with clinical decision support (CDS) have the
potential to reduce medication errors. The objective of this study was to evaluate
provider response to the dosing alerts in a CPOE system with CDS for pediatric inpatients
and to identify differences in provider response based on clinician specialty.
Patients and methods: We conducted a retrospective analysis of all medication dosing alerts over a 1-year
period (January 1 through December 31, 2008) for all pediatric inpatients at Hospital
for Special Surgery. Alerts were analyzed with respect to medication dosing, prescriber,
and action taken by the prescriber after the alert was triggered (i.e., accepted suggested
change, ignored recommendation/overrode, or cancelled the order).
Results: During the study period, 18,163 medication orders were placed and 1,024 dosing alerts
were fired. Overdosing of medications accounted for 91% of the alerts and underdosing
9%. The pediatric-trained providers ignored more alerts and cancelled fewer orders
than the non-pediatric-trained providers (p<0.001). Both groups changed the order
similarly based on CDS recommendations.
Conclusions: Differences in response to CDS were found between pediatric-trained and non-pediatric-trained
providers caring for pediatric patients; however, both groups changed orders based
on CDS similarly. CPOE with built-in CDS may be of particular value when providers
with different specialties and types of training are caring for pediatric patients.
Keywords
ADE - adverse drug events - CDS - clinical decision support; CIS - clinical information
system - CPOE - computerized provider order entry
