Abstract
Background. The ability of safety technologies to decrease errors, harm, and risk to patients has yet to be demonstrated consistently. Objective. To compare discrepancies between medication and intravenous fluid (IVF) orders and bedside infusion pump settings within a pediatric intensive care unit (PICU) before and after implementation of an interface between computerized physician order entry (CPOE) and pharmacy systems. Methods. Within a 72-bed PICU, medication and IVF orders in the CPOE system and bedside infusion pump settings were collected. Rates of discrepancy were calculated and categorized by type. Results were compared to a study conducted prior to interface implementation. Expansion of PICU also occurred between study periods. Results. Of 455 observations, discrepancy rate decreased for IVF (p = 0.01) compared to previous study. Overall discrepancy rate for medications was unchanged; however, medications infusing without an order decreased (p < 0.01), and orders without corresponding infusion increased (p < 0.05). Conclusions. Following implementation of an interface between CPOE and pharmacy systems, fewer discrepancies between IVF orders and infusion pump settings were observed. Discrepancies for medications did not change, and some types of discrepancies increased. In addition to interface implementation, changes in healthcare delivery and workflow related to ICU expansion contributed to observed changes.
Highlights
Medication errors are known to be a significant source of risk and harm to pediatric patients [1,2,3,4], in neonatal and pediatric intensive care units (PICUs) [5,6,7,8]
The study was performed in a 72-bed PICU with approximately 1800 admissions per year within a freestanding children’s hospital located in the Midwest
Orders for IV medication infusions and intravenous fluid (IVF) may be entered into the computerized physician order entry (CPOE) system by attending physicians, trainees, and nurse practitioners and physician assistants
Summary
Medication errors are known to be a significant source of risk and harm to pediatric patients [1,2,3,4], in neonatal and pediatric intensive care units (PICUs) [5,6,7,8]. In response to the errors and harm associated with medication infusions, the adoption of a range of healthcare information technologies including computer order physician entry (CPOE), bar coded medication administration, and “smart” infusion pumps has been recommended [12,13,14]. While these technologies have demonstrated the capacity to decrease the frequency of errors [15,16,17], results are mixed in studies trying to document reduction in harm. To compare discrepancies between medication and intravenous fluid (IVF) orders and bedside infusion pump settings within a pediatric intensive care unit (PICU) before and after implementation of an interface between computerized physician order entry (CPOE) and pharmacy systems. In addition to interface implementation, changes in healthcare delivery and workflow related to ICU expansion contributed to observed changes
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