? ? Despite the initial promise of computer order entry (CPOE), it is unclear that those centers that have ? implemented commercially available CPOE systems have realized benefits; with some centers reporting potentially worsened patient safety. One potentially significant aspect of CPOE implementation and use, which may ultimately determine the true benefit of CPOE, is the interaction between CPOE and a pharmacy information system (PhlS). The need for interfacing CPOE with a PhlS has been identified but is not well described in the literature. However, there are valid reasons to believe that it is precisely the lack of interface that prevents the full realization of CPOE's promise of assuring medication safety. This interface may have as significant an impact of medication errors, ADEs, workflow and working conditions as CPOE itself, bar coding technology, or Smart IV pumps, each of which has received federal funding for study. To address the lack of any research on medication safety interfaces (MSI) between CPOE and PhlS in general, and the lack of HIT research in pediatrics specifically, we propose an observational study in a pediatric hospital of the impact and value of this health information technology (HIT) on medication errors, quality of care, workflow, clinician working conditions, technology acceptance and cost-benefit.
The aims are to determine the impact ? of a MSI on (1) medication errors and quality of care (2) working conditions, employee outcomes, technology acceptance and workflow, and (3) the cost/benefit value of a MSI. This study represents a significant step in HIT and patient safety research for at least five reasons. First, the over 90% of US hospitals that have not implemented CPOE can benefit from the results. Second, this study will assess the impact of an MSI on not only medication errors, but also quality of care, working conditions, workflow, and economic factors, creating a more complete picture of value. Third, it is significant that this study will take place in a pediatric hospital since the complexity of health care delivery is compounded with children. Fourth, the acceptance of patient safety technology among end users will be modeled. Fifth, the evaluation will take place in the pediatric intensive care unit, neonatal intensive care unit, a general medical/surgery unit, and a hematology/oncology unit, providing a clear picture of MSI impacts. ? ? ? ?
