OBJECTIVES. This study was conducted to determine the impact of a computerized physician order entry system with substantial decision support on the incidence and types of adverse drug events in hospitalized children.METHODS. A prospective methodology was used for the collection of adverse drug events and potential adverse drug events from all patients admitted to the pediatric intensive care and general pediatric units over a 6-month period. Data from a previous adverse drug event study of the same patient care units before computerized physician order entry implementation were used for comparison purposes.RESULTS. Data for 1197 admissions before the introduction of computerized physician order entry were compared with 1210 admissions collected after computerized physician order entry implementation. After computerized physician order entry implementation, it was observed that the number of preventable adverse drug events (46 vs 26) and potential adverse drug events (94 vs 35) was reduced. Reductions in overall errors, dispensing errors, and drug-choice errors were associated with computerized physician order entry. There were reductions in significant events, as well as those events rated as serious or life threatening, after the implementation of computerized physician order entry. Some types of adverse drug events continued to persist, specifically underdosing of analgesics. There were no differences in length of stay or patient disposition between preventable adverse drug events and potential adverse drug events in either study period.CONCLUSIONS. This study demonstrated that a computerized physician order entry system with substantive decision support was associated with a reduction in both adverse drug events and potential adverse drug events in the inpatient pediatric population. Additional system refinements will be necessary to affect remaining adverse drug events. Preventable events did not predict excess length of stay and instead may represent a sign, rather than a cause, of more complicated illness.
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机译：目标这项研究旨在确定具有实质性决策支持的计算机医师医嘱输入系统对住院儿童药物不良事件的发生率和类型的影响。使用前瞻性方法收集了六个月期间所有接受儿科重症监护病房和普通儿科病房的患者的不良药物事件和潜在的不良药物事件。比较医生之前，在计算机化医师订单输入实施之前，来自同一患者护理部门的先前药物不良事件研究的数据。在引入计算机医师订单输入之前，将1197例入院数据与在实施计算机医师订单输入后收集的1210例入院数据进行比较。在计算机医师输入医嘱后，观察到可预防的不良药物事件（46 vs 26）和潜在的不良药物事件（94 vs 35）的数量减少了。总体错误，配药错误和药物选择错误的减少与计算机化的医生医嘱输入相关。在实施计算机医生订单输入后，重大事件以及被定为严重或威胁生命的事件有所减少。某些类型的药物不良事件持续存在，特别是止痛药的剂量不足。在两个研究期间，可预防的药物不良事件和潜在的药物不良事件在住院时间或患者处置方面均无差异。这项研究表明，具有实质性决策支持的计算机医师医嘱输入系统与住院儿科患者的不良药物事件和潜在的不良药物事件的减少相关。必须进行其他系统改进才能影响剩余的不良药物事件。可预防的事件并不能预测住院时间的长短，而是可能代表更复杂的疾病，而不是原因。
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