Longitudinal study of the manifestations and mechanisms of technology-related prescribing errors in pediatrics.

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  • Additional Information
    • Source:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 9430800 Publication Model: Print Cited Medium: Internet ISSN: 1527-974X (Electronic) Linking ISSN: 10675027 NLM ISO Abbreviation: J Am Med Inform Assoc Subsets: MEDLINE
    • Publication Information:
      Publication: 2015- : Oxford : Oxford University Press
      Original Publication: Philadelphia, PA : Hanley & Belfus, c1993-
    • Subject Terms:
      Medication Errors*/statistics & numerical data ; Medical Order Entry Systems* ; Decision Support Systems, Clinical* ; Electronic Health Records*; Humans ; Longitudinal Studies ; Hospitals, Pediatric ; Child ; Pediatrics
    • Abstract:
      Objectives: To examine changes in technology-related errors (TREs), their manifestations and underlying mechanisms at 3 time points after the implementation of computerized provider order entry (CPOE) in an electronic health record; and evaluate the clinical decision support (CDS) available to mitigate the TREs at 5-years post-CPOE.
      Materials and Methods: Prescribing errors (n = 1315) of moderate, major, or serious potential harm identified through review of 35 322 orders at 3 time points (immediately, 1-year, and 4-years post-CPOE) were assessed to identify TREs at a tertiary pediatric hospital. TREs were coded using the Technology-Related Error Mechanism classification. TRE rates, percentage of prescribing errors that were TREs, and mechanism rates were compared over time. Each TRE was tested in the CPOE 5-years post-implementation to assess the availability of CDS to mitigate the error.
      Results: TREs accounted for 32.5% (n = 428) of prescribing errors; an adjusted rate of 1.49 TREs/100 orders (95% confidence interval [CI]: 1.06, 1.92). At 1-year post-CPOE, the rate of TREs was 40% lower than immediately post (incident rate ratio [IRR]: 0.60; 95% CI: 0.41, 0.89). However, at 4-years post, the TRE rate was not significantly different to baseline (IRR: 0.80; 95% CI: 0.59, 1.08). "New workflows required by the CPOE" was the most frequent TRE mechanism at all time points. CDS was available to mitigate 32.7% of TREs.
      Discussion: In a pediatric setting, TREs persisted 4-years post-CPOE with no difference in the rate compared to immediately post-CPOE.
      Conclusion: Greater attention is required to address TREs to enhance the safety benefits of systems.
      (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Medical Informatics Association.)
    • Grant Information:
      APP1094878 NHMRC Partnership; APP1143941 NHMRC Early Career Fellowship; APP1094878 NHMRC; Sydney Children's Hospitals Network; eHealth, New South Wales; Office of Kids and Families, New South Wales; APP1174021 NHMRC
    • Contributed Indexing:
      Keywords: electronic health records; informatics; medication errors; patient safety; user-centered design
    • Publication Date:
      Date Created: 20240911 Date Completed: 20241216 Latest Revision: 20241216
    • Publication Date:
      20241217
    • Accession Number:
      10.1093/jamia/ocae218
    • Accession Number:
      39259924