CPOE effectiveness varies among pediatric hospitals

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An evaluation of computerized physician order entry and associated clinical decision support technology used at 41 children’s hospitals determined there to be wide variation in the effectiveness of such tools.

The study, in which researchers examined simulated scenarios from February 2008 to December 2010 using an evaluation tool developed by the Leapfrog Group, found that while, on average, pediatric CPOE systems were able to catch 62 percent of potential medication errors. Researchers also found that effectiveness ranged from slightly less than 23 percent at the lowest hospital to 91 percent at the highest; the research was published in the Journal of the American Medical Informatics Association.

“[T]he effectiveness of CDS to identify actual unsafe scenarios has previous been shown to vary quite significantly among institutions, even those using the same [electronic health record] vendor,” the authors said. “In our study, we found that although the pediatric institutions tested are identifying over 60 percent of simulated ordering errors and are consistently improving, areas in need of significant improvement remain, particularly within the advanced clinical decision support areas.”

Notably, allergies and cross-allergies were identified with the most reliability by the tools, with an average score of 99.2 percent. The tools were able to identify inappropriate single and cumulative daily dosages at high rates, as well, at 81.1 percent and 70.2 percent, respectively. However, identification of dosages for situations in which a drug should not have been used due to a patient’s diagnosis was low (28.9 percent).

“Dosing is among the most critical sources of medication errors in the pediatric population, principally because of the need for weight- and age-based dosing that reflects the varied pharmacodynamics of children,” the authors said.

Research published in January 2015 found that a high percentage of erroneous medication orders were able to “sail through” CPOE systems with little or no difficulty or warnings. And according to a study published earlier this year in Mayo Clinical Proceedings, use of electronic health records and CPOE reduced physician satisfaction and contributed to higher rates of burnout.

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