Critical Care Clinical Trial
Official title:
Prevention of Potential Errors in Resuscitation Medications Orders by Means of a Computerized Physician Order Entry With Clinical Decision Support System in Pediatric Critical Care – a Prospective Cohort Study.
Computerized physician order entry with clinical decision support system CPOE+CDSS)completely eliminated errors in filling in the resuscitation medications order forms and significantly reduced time to completing the forms in a pediatric critical care department (PCCD).
Introduction: Computerized physician order entry with clinical decision support system
(CPOE+CDSS) is an important tool in attempting to reduce medication errors. The objective of
this study was to evaluate the impact of a CPOE+CDSS on (1) the frequency of errors in
ordering resuscitation (CPR) medications and (2) the time for printing out the order form,
in a pediatric critical care department (PCCD).
Methods: Setting: An 18-bed PCCD in a tertiary-care children’s hospital. Design: Prospective
cohort study. Measures: Compilation and comparison of number of errors and time to fill in
forms before and after implementation of CPOE+CDSS. Errors were identified by reviewing
orders and classified as potential adverse drug events (ADEs), medication prescribing errors
(MPEs), and rule violations (RVs). They were compared during the year preceding and
following implementation of CPOE CDSS. Simulated forms were also used to further test error
occurrence. Time to fill in conventional, simulated and CPOE forms was measured and
compared.
Results: There were 3 reported incidents of errors among 13,124 CPR medications orders
during the year preceding implementation of CPOE+CDSS. These represent errors that escaped
the triple check by three independent staff members (two nurses and one physician). There
was an average of 11.6 errors/100 orders in the simulated CPR form and potential ADEs
occurred at a rate of 11.3/100 orders and MPEs at a rate of 0.3/100 orders. There were no
errors after CPOE+CDSS was implemented (100% error reduction). Time to completion of drug
forms dropped from 14 min 42 sec to 2 min 14 sec (p<0.001).
Conclusions: CPOE+CDSS completely eliminated errors in filling in the forms and
significantly reduced time to completing the form.
;
Observational Model: Defined Population, Time Perspective: Longitudinal
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