Retrospective evaluation of a computerized physician order entry adaptation to prevent prescribing errors in a pediatric emergency department

Abstract

Objective: The goal was to determine the impact on medication prescribing errors of adding a pediatric medication list (quicklist) to a computerized physician order entry system in a pediatric emergency department.

Methods: The quicklist is a drug dosing support tool that targets the most common medications in our clinical setting. We performed a retrospective comparison of orders from 420 randomly selected visits before and after quicklist introduction. Error rates were analyzed with respect to urgency level, physician training level, and patient age. The quicklist was examined for frequency of use and error rates.

Results: The 840 patient visits (420 before intervention and 420 after intervention) generated 724 medication orders, which contained 156 medication prescribing errors (21%). The groups did not differ with respect to urgency level, physician training level, or patient age. There were significant decreases in the rate of errors per 100 visits, from 24 to 13 errors per 100 visits, and in the rate of errors per 100 orders, from 31 to 14 errors per 100 orders. The decrease in the error rates did not vary according to urgency score, age group, or physician training level. The quicklist was used in 30% of the orders in the postintervention group. In this group, the error rate was 1.9 errors per 100 orders when the quicklist was used, compared with 18.3 errors per 100 orders when the list was not used. Errors of wrong formulation, allergy, drug-drug interaction, and rule violations were eliminated.

Conclusion: The introduction of the quicklist was followed by a significant reduction in medication prescribing errors. A list with dosing support for commonly used pediatric medications may help adapt computerized physician order entry systems designed for adults to serve pediatric populations more effectively.