Pediatric hospitals show wide gap in EHR safety performance

Research led by a top informatics officer at Rady Children’s Hospital shows improvement is needed in using CPOE to reduce medication errors.

While pediatric hospitals using computerized physician order entry and clinical decision support in electronic health record systems are able to intercept a majority of potential medication errors, researchers have found that these healthcare organizations vary widely in their safety performance.

Children are particularly vulnerable to medication errors, which is why hospitals have been leveraging CPOE with associated clinical decision support in their EHRs to reduce medication errors and subsequent adverse drug events, according to the researchers.

“Use of CPOE for hospitalized children has demonstrated a reduction in some types of medication errors, but results have been variable,” they contend in a recent article published in the Journal of the American Medical Informatics Association.

Over a two-year period, Leapfrog Group’s pediatric CPOE evaluation tool was used to assess the ability of 41 pediatric hospitals to identify orders that could potentially lead to patient harm.

“We sought to evaluate the state of CPOE implementation in pediatric settings, but also to assess whether use of the CPOE evaluation tool could motivate further improvement within a given institution,” according to the authors.

In looking at the safety performance of EHR systems in 41 children’s hospitals, researchers reported that although pediatric CPOE systems were able to identify 62 percent of potential medication errors in the test scenarios, they ranged widely from 23 percent to 91 percent in the institutions tested.

“It’s a very wide gap, and it really demonstrates the fact that a lot of this variability is not dependent on hospitals’ EHR vendors but on the actual implementation at each individual hospital,” says Juan Chaparro, MD, physician instructor with the Departments of Biomedical Informatics and Pediatrics at the University of California-San Diego and assistant medical informatics officer at Rady Children’s Hospital, who was the principal investigator on the study.

Also See: EHR, CPOE use linked to physician burnout and dissatisfaction

Chaparro adds that one of the most surprising findings was that there wasn’t a correlation between the length of time since an EHR and CPOE was implemented and positive scores.

“Scores for hospitals that had implemented systems over 12 years were not significantly higher than those that implemented within the last year or two,” according to Chaparro. “It’s very dependent on the hospitals to make the effort to implement their clinical decision support. And while some hospitals performed admirably, there were significant laggards in overall scores.”

“We initially hypothesized that early adopters would have continued to develop decision support over the interval and would thus have superior scores,” states the article. “Instead, we found no relationship between time since implementation and the institution’s performance on initial Leapfrog testing.”

At the same time, however, researchers observed that pediatric CPOE systems showed significant improvement in test scores of four percentage points per year with repeated testing using the Leapfrog tool, suggesting that such evaluations of CPOE/CDS systems may lead to improved ability to intercept potential medication errors.

“We need to reinstitute pediatric testing to continue improving patient safety, whether it’s the Leapfrog tool or some other,” concludes Chaparro, who adds that a pediatric Leapfrog test is not currently available. “Some sort of iterative testing is going to be needed to help hospitals improve their clinical decision support.”

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