title: Impact of computerized prescriber order entry on the incidence of adverse drug events in pediatric inpatients.
abstract: OBJECTIVE
  This study was conducted to determine the impact of a computerized physician order entry system with substantial decision support on the incidence and types of adverse drug events in hospitalized children.
  
  
  METHODS
  A prospective methodology was used for the collection of adverse drug events and potential adverse drug events from all patients admitted to the pediatric intensive care and general pediatric units over a 6-month period. Data from a previous adverse drug event study of the same patient care units before computerized physician order entry implementation were used for comparison purposes.
  
  
  RESULTS
  Data for 1197 admissions before the introduction of computerized physician order entry were compared with 1210 admissions collected after computerized physician order entry implementation. After computerized physician order entry implementation, it was observed that the number of preventable adverse drug events (46 vs 26) and potential adverse drug events (94 vs 35) was reduced. Reductions in overall errors, dispensing errors, and drug-choice errors were associated with computerized physician order entry. There were reductions in significant events, as well as those events rated as serious or life threatening, after the implementation of computerized physician order entry. Some types of adverse drug events continued to persist, specifically underdosing of analgesics. There were no differences in length of stay or patient disposition between preventable adverse drug events and potential adverse drug events in either study period.
  
  
  CONCLUSIONS
  This study demonstrated that a computerized physician order entry system with substantive decision support was associated with a reduction in both adverse drug events and potential adverse drug events in the inpatient pediatric population. Additional system refinements will be necessary to affect remaining adverse drug events. Preventable events did not predict excess length of stay and instead may represent a sign, rather than a cause, of more complicated illness.
authors.affiliation: College of Pharmacy, MSC09 5360, 1 University of New Mexico, Albuquerque, NM 87131-0001, USA. mholdsworth@salud.unm.edu
authors.forename: Mark T
authors.initials: MT
authors.lastname: Holdsworth
authors.forename: Richard E
authors.initials: RE
authors.lastname: Fichtl
authors.forename: Dennis W
authors.initials: DW
authors.lastname: Raisch
authors.forename: Adrianne
authors.initials: A
authors.lastname: Hewryk
authors.forename: Maryam
authors.initials: M
authors.lastname: Behta
authors.forename: Elena
authors.initials: E
authors.lastname: Mendez-Rico
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Wong
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cohen
authors.forename: Susan
authors.initials: S
authors.lastname: Bostwick
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Greenwald
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D050316:Medical Order Entry Systems / Q000639:trends*; D008508:Medication Errors / Q000379:methods / Q000639:trends*; D010607:Pharmacy Service, Hospital / Q000379:methods / Q000639:trends; D011446:Prospective Studies