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Pediatric patients are particularly vulnerable to prescribing errors.
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Research on the impact of CPOE systems for pediatric patients is growing.
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CPOE has tremendous potential for improving patient safety but can also have unintended consequences.
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Much of the research on the effectiveness of CPOE among pediatric patients has been on reduction in prescribing errors.
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Future research should focus on the effectiveness of CPOE with CDS on actual outcomes for pediatric patients, and other workflow and
Computerized Provider Order Entry and Patient Safety
Section snippets
Key Points
Definitions
CPOE refers to a provider's use of computer assistance to directly enter medical orders, such as medications, consultations with other providers, laboratory services, imaging studies, and other auxiliary services. CPOE is often used to describe this process in the inpatient setting. Electronic transmission of prescriptions directly to pharmacies (ePrescribing) is commonly an associated functionality.
Much of the value of CPOE is believed to come from clinical decision support (CDS). CDS refers
Medication errors
Medication errors can occur at any step in the medication process (defined by the Institute of Medicine as prescribing, transcribing, dispensing, administering, and monitoring a medication).1 CPOE largely targets prescribing errors. Common types of prescribing errors include incorrect dosing (overdosing and underdosing); incorrect drug selection; incorrect frequency; wrong patient; incorrect route of administration; and illegibility (for handwritten orders). Near misses are a type of error with
The epidemiology of pediatric medication errors
Research on the epidemiology of pediatric medication errors suggests these errors occur with great frequency. In the inpatient setting, a study conducted by Kaushal and colleagues3 found that 5.7% of handwritten inpatient orders contained prescribing errors with low potential for harm; 1.1% contained near misses; and 0.24% resulted in ADEs, of which 19% were preventable. Importantly, the rate of near misses was triple that compared with adults.7 Most errors occurred at the prescribing stage and
The unique vulnerability of children to medication errors
Children seem to be particularly vulnerable to medication errors and ADEs for a variety of reasons (Box 1).1, 2, 3 Some factors are intrinsic to the nature of being a child, whereas others are related to how medications are ordered and used among pediatric patients.
Proposed benefits of CPOE
Given the scope of the problem facing pediatric patients, HIT is increasingly being promoted and used as a way to improve patient safety. Indeed, use of CPOE is one of the core requirements providers must demonstrate to be eligible for financial incentives through the electronic health record (EHR) incentive program, an unprecedented federal initiative promoting adoption and meaningful use of EHRs.4 The emphasis being placed on use of CPOE stems from the many potential benefits of CPOE use.
Impact of CPOE systems on patient safety
In the inpatient and outpatient setting, multiple studies have shown that CPOE can reduce the frequency of medication errors for adult patients.24, 25, 26, 27, 28 For example, a study conducted by Bates and colleagues25 evaluating medication errors among adult inpatients found that CPOE eliminated more than 80% of nonmissed drug medication errors. In the outpatient setting, a recent study of community-based ambulatory care adult providers found that introduction of electronic order entry
Unintended consequences of CPOE
Although CPOE has tremendous promise, there are also important pitfalls. Several studies have evaluated unintended consequences after CPOE implementation. Unintended consequence is the term often used to describe a consequence that is unanticipated and undesirable.
One important type of unintended consequence of CPOE implementation is the fostering of new types of errors.38, 39, 40, 41, 42 One such error is a juxtaposition error, in which the clinician inadvertently chooses the incorrect patient
Policy implications and future directions
For many years, rates of CPOE adoption and use by hospitals and ambulatory providers were extremely low. However, these rates have been steadily increasing, and are expected to continue to increase dramatically in light of the federal incentives provided through the EHR incentive program. As of 2010, an estimated 21.7% of US hospitals had CPOE, compared with only 15.7% in 2009.47 Among eligible ambulatory providers, 390,000 prescribed electronically (58% of all office-based prescribers). This
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Cited by (34)
Nursing errors and Computerized Provider Order Entry (CPOE)
2021, Informatics in Medicine UnlockedCitation Excerpt :Are beneficial for nurses. Abramson et al. examined the impact of drug interaction management and drug sensitivity assessment on the CPOE as an essential way to reduce drug errors [31]; While Mattison et al. has shown that the ability to issue alerts by the CPOE is its most crucial function to reduce medication errors [32]. The nurses of these two hospitals probably ignored the importance of this clinical information system's warning mechanism in reducing nursing errors due to lack of knowledge.
A preliminary analysis on CPOE functioning in Mississippi and implications for future research
2016, Health Policy and TechnologyCitation Excerpt :Findings pertaining to the implementation of the CPOE system on patient system are mixed. Some researchers claimed that the CPOE system has led to improvements in patient safety [26,27] while others found that the introduction of a CPOE system can be detrimental to patient safety [28]. Findings pertaining to the implementation of the CPOE system on mortality rates are also mixed.
Impact of monitoring surgical prophylactic antibiotics and a computerized decision support system on antimicrobial use and antimicrobial resistance
2016, American Journal of Infection ControlPhysicians Failed to Write Flawless Prescriptions When Computerized Physician Order Entry System Crashed
2015, Clinical TherapeuticsCitation Excerpt :Some data are necessary to provide. One of the strengths of a CPOE system over handwritten prescriptions is that the completeness of data can be enforced by computers.15 In some earlier analyses of prescriptions at the outpatient settings where the CPOE system had not been implemented, approximately 46% to 73% of handwritten prescriptions lacked essential information.2,16,17
Improving medication safety in a paediatric hospital: A mixed-methods evaluation of a newly implemented computerised provider order entry system
2023, BMJ Health and Care InformaticsHealth, Digital Health and Decision Support: Sisyphus and Pandora
2022, Studies in Health Technology and Informatics