Effect of computer order entry on prevention of serious medication errors in hospitalized children.
OBJECTIVE
Although initial research suggests that computerized physician order entry reduces pediatric medication errors, no comprehensive error surveillance studies have evaluated the effect of computerized physician order entry on children. Our objective was to evaluate comprehensively the effect of computerized physician order entry on the rate of inpatient pediatric medication errors.


METHODS
Using interrupted time-series regression analysis, we reviewed all charts, orders, and incident reports for 40 admissions per month to the NICU, PICU, and inpatient pediatric wards for 7 months before and 9 months after implementation of commercial computerized physician order entry in a general hospital. Nurse data extractors, who were unaware of study objectives, used an established error surveillance method to detect possible errors. Two physicians who were unaware of when the possible error occurred rated each possible error.


RESULTS
In 627 pediatric admissions, with 12,672 medication orders written over 3234 patient-days, 156 medication errors were detected, including 70 nonintercepted serious medication errors (22/1000 patient-days). Twenty-three errors resulted in patient injury (7/1000 patient-days). In time-series analysis, there was a 7% decrease in level of the rates of nonintercepted serious medication errors. There was no change in the rate of injuries as a result of error after computerized physician order entry implementation.


CONCLUSIONS
The rate of nonintercepted serious medication errors in this pediatric population was reduced by 7% after the introduction of a commercial computerized physician order entry system, much less than previously reported for adults, and there was no change in the rate of injuries as a result of error. Several human-machine interface problems, particularly surrounding selection and dosing of pediatric medications, were identified. Additional refinements could lead to greater effects on error rates.
Walsh
Kathleen E
KE
Department of Pediatrics, University of Massachusetts Medical School/UMass Memorial Medical Center, Worcester, Massachusetts 01655, USA. walshk02@ummhc.org
Landrigan
Christopher P
CP
Adams
William G
WG
Vinci
Robert J
RJ
Chessare
John B
JB
Cooper
Maureen R
MR
Hebert
Pamela M
PM
Schainker
Elisabeth G
EG
McLaughlin
Thomas J
TJ
Bauchner
Howard
H
D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D004360:Drug Therapy, Computer-Assisted; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007363:Intensive Care Units, Neonatal; D015278:Intensive Care Units, Pediatric; D008297:Male; D050316:Medical Order Entry Systems; D016347:Medical Records Systems, Computerized; D008508:Medication Errors / Q000517:prevention & control* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D017751:Safety Management / Q000706:statistics & numerical data; D017749:Total Quality Management; D014481:United States