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Published on 27 November 2007

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Computer order system cuts prescription errors


The use of a computerised prescriber order entry (CPOE) system helps to reduce the incidence of adverse drug events (ADEs) in paediatric inpatients, according to study findings published in Pediatrics.

The study included 1,197 consecutive paediatric patients admitted to either the PICU or the general paediatric unit at a single tertiary care centre in the US between April 2004 and October 2004.

The data was compared to that collected from September 2000 to May 2001 as part of a previous study conducted in the same centre prior to the introduction of CPOE (1,210 admissions).

An ADE was defined as an injury from a medicine or lack of an intended medicine. A potential ADE was defined as an error that had the potential to result in at least a significant injury (this included those detected prior to administration); a preventable ADE was defined as those associated with a medication error.

The primary drug reviewer was a clinical pharmacist who reviewed identified events on a daily basis; in addition nursing and pharmacy supervisory personnel were interviewed weekly to obtain any further reports of adverse events. The primary reviewer was responsible for assigning proximal cause and systems failure to each case, for example lack of drug knowledge and lack of information about the patient.

There was a significant reduction in total ADEs, preventable ADEs and potential ADEs after the implementation of the CPOE system. Specifically, the main findings were as follows:

• The total number of preventable ADEs was 46 in the study period prior to CPOE introduction and 26 in the period following implementation (RR of 0.56; 95% CI 0.34–0.91). In terms of preventable ADEs per 100 patient-days, this was 4.5 versus 3.4, respectively;

• The number of potential ADEs was 94 prior to CPOE versus 35 post-CPOE implementation (RR 0.37; 95% CI 0.25–0.55). For potential ADEs per 100 patient-days, the respective figures were 9.3 versus 2.4;

• Similar reductions were found for all of those events rated as serious or life-threatening between the two time periods (pre-CPOE [n = 13] and post-CPOE [n = 3]; RR 0.23; 95% CI 0.07–0.80);

• NNT analysis found that CPOE was associated with the avoidance of one potential ADE every 20.2 admissions (95% CI: 13.9–30.0 admissions) and one preventable ADE every 59.0 admissions (95% CI: 36.2–96.1 admissions);

• The most common type of preventable event in both time periods was inadequate analgesia, which the introduction of CPOE did not appear to have an effect upon (pre-CPOE period: n = 28; post-CPOE: n = 29). CPOE implementation reduced ADEs associated with aminoglycosides (12 vs 0) and cephalosporins (14 vs 2), including those in relation to dose frequency standardisation and medication order tracking;

• Events resulting from lack of drug knowledge were less prevalent in the post-CPOE group (n = 34) compared with the pre-CPOE group (n = 54; RR: 0.62; 95% CI: 0.40–0.96), and errors associated with dose and scheduling were reduced.

The authors concluded that although the introduction of a CPOE system had reduced ADEs among paediatric inpatients, some continued to occur and additional system modifications would therefore be necessary to affect the remainder of these events.




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