Background and Importance Prescribing errors represent a safety risk for hospitalised patients, especially in paediatric s.¹ Computerised physician order entry (CPOE) might reduce prescribing errors, although its effect has not yet been thoroughly studied on paediatric general wards.

Aim and Objectives This study investigated the impact of a CPOE on prescribing errors in children on general wards at a University Children’s Hospital.

Material and Methods We performed medication reviews on 1000 patients from 0 – 18 years on paediatric general wards before and after the implementation of a CPOE. The CPOE included limited clinical decision support (CDS) such as a drug-drug interaction check and checks for duplicates. Prescribing errors, their type according to the PCNE classification, their severity (adapted NCC MERP index) as well as the interrater reliability (Cohen’s Kappa) were analysed.

Results CPOE significantly reduced the rate of errors from 25 errors/100 prescriptions (95% CI: 23 – 27) to 16 errors/100 prescriptions (95% CI 14 – 18). Particularly the prescribing quality was improved by reducing PCNE error 5.2 (e.g. lacking drug form or maximum possible number of doses for reserve medication). Medication reconciliation problems (PCNE error 8), such as drugs prescribed on paper as well as electronically, were significantly increased after introduction of the CPOE. The most common paediatric prescribing errors, the dosing errors (PCNE errors 3), were not statistically significantly altered after introduction of the CPOE. Overall severity of errors was reduced. Interrater reliability showed moderate agreement (Κ = 0.48).

Conclusion and Relevance The CPOE increases patient safety by reducing the rate and severity of prescribing errors. The reason for the observed increase in medication reconciliation problems might be the hybrid-system with remaining paper-prescriptions for special medication. The lacking effect on dosing errors might be explained by the fact that a web application CDS covering dosing recommendations (PEDeDose) was already in use before implementation of the CPOE. Further investigations should focus on eliminating hybrid systems, interventions on how to increase the usability of the CPOE, and full integration of CDS tools into the CPOE.

References and/or Acknowledgements 1. Gates PJ, et al. Prevalence of medication errors among paediatric inpatients: systematic review and meta-analysis. Drug Saf 2019;42:1329–1342

Conflict of Interest Corporate sponsored research or other substantive relationships:

This study was funded by the grant for the scientific project of national reach 2014 of the Swiss Association of Public Health Administration and Hospital Pharmacists (GSASA).