Objective: Computerized provider order entry (CPOE) has been noted to significantly reduce the incidence of medication errors. We hypothesized that using computerized provider order entry with medication dose range checking would be effective in reducing the rate of prescribed overdoses in children. Furthermore, we hypothesized that voluntary reporting of incidents associated with adverse drug events (ADEs) would significantly underestimate the actual number of these events.
Methods: Utilizing a query of the pharmacy information system, the number of administered doses of 3 study medications (opioids, benzodiazepines, and potassium) and of their antidotes (naloxone, flumazenil, and sodium polystyrene) for the period prior to implementing computerized provider order entry (March-September 2002) was compared with the number following implementation (April-July 2003). The medical records of these patients were reviewed and the rate of prescribed overdoses with associated antidote administration determined. A search of the incident reporting system determined whether each event was reported.
Results: Prior to computerized provider order entry, 13,997 opioid medications were prescribed and 8 doses of naloxone were administered in response to a prescribing error and adverse drug event (0.572 events/1000 doses). After computerized provider order entry implementation, 7256 opioid medications were prescribed and 1 dose of naloxone was administered (0.138 events/1000 doses) (P = 0.17). Only 1 (11%) of these serious adverse drug events resulted in an incident report.
Conclusions: Computerized provider order entry with medication dose range checking was associated with a clinically significant fourfold reduction in opioid prescribing errors requiring antidote administration. Voluntary incident reporting significantly underestimates the actual incidence of serious ADEs in this tertiary care children's hospital. Computerized provider order entry electronic query is effective in detecting low frequency adverse drug events that may otherwise go unnoticed.