Prescription errors related to the use of computerized provider order-entry system for pediatric patients

Objectives: To evaluate the nature and frequency of medication errors resulting from the use of a computerized provider order-entry (CPOE) system in a pediatric department.

Methods: We conducted a retrospective study to examine errors related to computerized orders using the software Pharma^® (Computer Engineering, France) in pediatric department between 31/05/2015 to 01/12/2015. These errors were signaled by pharmacists who examine CPOEs daily.

Results: A total of 302 pharmacist interventions (PharmInt) were carried out by clinical pharmacists during the study period. Of the 302 PharmInts, a total of 95 (31.5%) contained no data on the patient's bodyweight, which should have been provided by the prescriber (Table 1). After the PharmInt, information on bodyweight was then provided in 47 of these cases (15.6%). Incomplete information about administration frequency accounted for 19.9% of total PharmInts. Prescribing an excessive dose occurred in 17.6% of PharmInts, inappropriate modifications of prescription unit accounted for 9.9% of PharmInts, and incorrect dosage was prescribed in 8.3% of PharmInts. Of the 302 PharmInts, 255 concerned prescription errors and bodyweight missing not provided after PharmInt. Paracetamol, in its different forms (injectable, solid or liquid oral forms) accounted for 35.7% of total PharmInts. Noted errors for paracetamol included an incorrect dosage form, co-administration of two paracetamol-containing drugs, modification of the prescription unit, incorrect frequency of administrations, and absence of the patient's bodyweight. Inconsistent use of a contradicted or a non-used drug for pediatric patients was noted along with prescriptions for inadequate dosages.

Discussion and conclusion: Our work revealed several error types in prescribing for pediatric patients, mainly absence of bodyweight, incorrect frequency of administration and excessive doses. Information on bodyweight is crucial in pediatric patients: our study highlights the need to make it mandatory to complete prescriptions via CPOE systems. The role of better software design is pivotal to avoiding these errors. In addition to optimizing the quality of CPOE-entries, well-designed software, better-trained users, and improved communication among healthcare will reduce errors.