Objective: To assess the prolonged impact of computerized physician order entry (CPOE) on medication prescription errors in pediatric intensive care patients.
Study design: This observational study was conducted at a pediatric intensive care unit (PICU) in which a CPOE (Metavision®, iMDsoft, Israel) with a limited clinical decision support system (CDSS) was implemented between 2004 and 2007. Since then no changes were made to the systems. We analyzed 2500 electronic prescriptions (1250 prescriptions from 2015 and 1250 prescriptions from 2016). Prescription errors were identified by a pediatric intensive care physician and classified as potential adverse drug events (pADE), medication prescription errors (MPE), or rule violations (RV). Their prevalence was compared to the rate in 2007, reported in a previous study from the same unit. A randomly selected 10% of the prescriptions were also analyzed by the PICU pharmacist, and the level of agreement was determined.
Results: The rate of prescription errors increased from 1.4% in 2007 to 3.2% in 2015 (P=0.03). Following revision of the CDSS tools, prescription errors decreased to 1% in 2016 (P<0.0001). The pADE rate dropped from 2% in 2015 to 0.7% in 2016 (P=0.006), and the MPE rate, from 1% to 0.2% (P=0.01). The agreement between the two reviewers was excellent (k=0.96).
Conclusion: The rate of prescription errors may increase with time from implementation of a CPOE. Repeated surveillance of prescription errors is highly advised to plan strategies to reduce them. This approach should be considered in quality improvement of computerized information systems in general.
