The effect of a computerized physician order entry system on managing continuous infusion medications at a pediatric intensive care unit

Abstract

Background. Errors of continuous infusion medications are very common in pediatrics and can be life threatening. The "rule of 6" manual equation introduces a major risk for calculation errors as a result of formulating individualized concentrations. The JCAHO has mandated transition from the rule of 6 to standardized concentrations. This transition was achieved through the creation of a CPOE system specific to pediatric patients. The effect of CPOE on medication errors, efficiency, and user satisfaction as critical factors for system success has been insufficiently addressed in the literature. Objectives. To examine the effect of CPOE on efficiency, medication errors, user satisfaction, and the check-methods used to verify pump settings accuracy. Methods. A repeated measures design within a simulation environment was utilized. Data were collected from a convenience sample of 26 residents, 10 pharmacists, and 36 nurses in a pediatric intensive care unit with the order of treatment conditions (CPOE and handwritten system) randomly assigned. Data collection tools included: time to measure efficiency; medication order sheets, drip labels, and a checklist to verify pump settings accuracy for medication errors; a checklist for identifying and ranking of check-methods used; and a questionnaire for user satisfaction. Results. CPOE required less time across the stages of the medication management process (p < .05). CPOE eliminated all types of prescribing errors except for missing signature and resulted in 80% to 86% reduction of dispensing errors (p < .05); however, the system did not decrease medication administration errors. Users were more satisfied with CPOE as compared to the handwritten system (p < .05). The number of check-methods used by nurses was comparable in both systems. Inconsistent use of computerized order sheets was found among nurses and pharmacists. Conclusions. CPOE is an effective and efficient solution to satisfy the JCAHO mandate. However, CPOE is not a panacea. Appropriate use of the technology and careful integration of CPOE into the pharmacy system is critical to maintain patient safety. Future studies should focus on the transferability of the system to other units and on the use of computerized order sheets and infusion pumps by nurses.