Computerized Order Entry With Limited Decision Support to Prevent Prescription Errors in a PICU

Abstract

CPOE implementation decreased prescription errors only to a small extent. However, the addition of a CDSS that limits doses by weight significantly reduced prescription error rates and, most importantly, potential ADEs. This finding emphasizes the major impact of weight-based calculation errors in pediatrics.

Erros De Medicação Em Pediatria E Estratégias De Prevenção: Revisão Integrativa

“…Unidades pediátricas gerais aparecem como maior foco dos estudos (66,6%), entre elas, unidades de internação clínica e unidades cirúrgicas (9,(11)(12)(13)(17)(18)(19)(20)(21)(22)(23)25,(27)(28)(29)(31)(32)35) . A Unidade de Terapia Intensiva (UTI) foi o setor isolado mais estudado (18,5%) (2,10,24,26,30) . Dos estudos que propuseram intervenções, observou-se que poucos seguiram uma proposta metodológica clássica com análise estatística.…”

Computerized decision support in adult and pediatric critical care

“…CDS tools used in outpatient care document improved adherence to recommended vaccine schedules and adherence to recommended asthma care [14,15] . CPOE, with integrated CDS, decreases medical errors and improves pharmacy costs over time [16][17][18][19][20] . CDS tools have improved care in time-sensitive disease states including septic shock [21] .…”

“…Ventilator fraction of inspired oxygen [41] Pressure support ventilation [42] Antibiotic recommendation [43,44] Blood glucose control [46][47][48] Sepsis [21] Heparin dosing after myocardial infarction [45] Research Mortality prediction [29] Prediction of fluid requirement [53] Predictive alerts for hemodynamic instability [49][50][51] Ventilator settings [76] Prediction of dialysis need [52] Insulin e-protocol [54,85] Pediatric and neonatal critical care Diagnostic ISABEL (www.isabelhealthcare.com) [59,86] SimulConsult (www.simulconsult.com) [87] MEDITEL pediatric diagnostic system [58] Outcome prediction and severity of illness [55][56][57] Alert and Reminder Drug interaction [62] Prescription errors and adverse drug events [18,61] Parenteral nutrition orders [61] NICU pulse oximeter [60] Protocol/Procedure Blood transfusions [63] Medications [61] Parenteral nutrition [64] Management Oxygen in ventilated newborns [68] Antibiotic recommendation [44,65] Blood glucose control [69] Medication information databases [88] Medication dosing calculators [61] Ventilator management in neonates [66,67] Research Virtual PICU (www.pi...…”

“…PRISM models and score for acute neonatal physiology (SNAP) models are validated tools for mortality risk prediction in pediatric and neonatal patients [55,56] . CDS alerts improve patient safety and are used to warn of drug interactions and adverse events and to improve the specificity of monitor alarms [18,[60][61][62] . Kadmon et al [18] found alert CDS tools integrated with CPOE significantly decreased dosing order errors and potential adverse events in a pediatric ICU.…”

“…CDS alerts improve patient safety and are used to warn of drug interactions and adverse events and to improve the specificity of monitor alarms [18,[60][61][62] . Kadmon et al [18] found alert CDS tools integrated with CPOE significantly decreased dosing order errors and potential adverse events in a pediatric ICU. Similarly, use of these tools reduced parenteral nutrition order errors in the neonatal ICU [61] .…”