Study Finds Wide Variability in Effectiveness of CPOE Tools in Pediatric Hospitals
Researchers investigating the safety of computerized physician order entry (CPOE) systems at pediatric inpatient facilities found while systems on average are able to intercept a majority of potential medication errors, their effectiveness varied widely among implementations.
The research team, led by Juan Chaparro with the department of biomedical informatics and pediatrics at the University of California, San Diego and Rady Children’s Hospital in San Diego, used the Leapfrog Group’s pediatric CPOE evaluation tool as part of their examination into the safety of CPOE and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the U.S.
The Leapfrog Group’s pediatric CPOE evaluation tool is a validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm.
Researchers used the pediatric CPOE evaluation tool to examine 41 pediatric hospitals over a two-year period. Evaluation of the last available test for each institution was performed, assessing performance overall as well as by decision support category, such as drug-drug interactions and dosing limits. Longitudinal analysis of test performance was also carried out to assess the impact of testing and the overall trend of CPOE performance in pediatric hospitals, according to the study authors.
The research team found that the pediatric CPOE systems were able to identify 62 percent of potential medication errors in the test scenarios. However the systems ranged widely from 23 percent to 91 percent in the hospitals tested.
The highest scoring categories included drug-allergy interactions, dosing limits (both daily and cumulative), and inappropriate routes of administration.
“We found that hospitals with longer periods since their CPOE implementation did not have better scores upon initial testing, but after initial testing there was a consistent improvement in testing scores of four percentage points per year,” the study authors wrote.
The researchers concluded that pediatric CPOE systems, on average, are able to intercept a majority of potential medication errors, but vary widely among implementations.
“Prospective and repeated testing using the Leapfrog Group’s evaluation tool is associated with improved ability to intercept potential medication errors,” the study authors concluded.
