May 2003

Document Type


Degree Name



Dept. of Medical Informatics and Clinical Epidemiology


Oregon Health & Science University


Iatrogenic injuries are common among hospitalized patients and are frequently preventable. The Institute of Medicine (IOM) reported that an estimated 44,000 to 98,000 people die each year in the United States at least in part due to medical error. The accuracy of the IOM study has been questioned by some experts while supported by others, but this controversy does not detract from the fact the injuries due to medical errors are a significant problem. The Harvard Medical Practice Study has shown that many adverse events experienced by patients are due to complications of medication use. Subsequent studies have confirmed that adverse drug events (ADEs) are common, costly and often severe. Although medication errors are common in the inpatient setting in both adults and children, potential harm to children as a result of medication errors may be greater than it is in adults. Low weights, rapid weight changes, requirements for weight-based dosing, concentrated medication formulations, and low infusion rates for intravenous medications are among the factors that contribute to potential medication errors in pediatric patients. Three strategies, some of which have been shown to be effective in adults, have been suggested for preventing medication errors and adverse drug events in pediatric inpatients: 1. clinical pharmacist presence during work rounds, 2. computerized provider order entry (CPOE) with clinical decision support systems (CDSS), and 3. improved communication among physicians, nurses and pharmacists. The primary purpose of this project is to examine the second strategy, the use of CPOE and CDSS in pediatric inpatients, especially as it pertains to reducing medication errors and the potential adverse events associated with these errors. In addition to reviewing the literature on CPOE, medication safety, and ADEs with an emphasis on pediatrics, the following items will be addressed: 1. A current state workflow analysis of medication ordering in children with a focus on normalized dosing (weight-based and body surface area-based dosing). 2. A future state workflow of medication ordering in children assuming the availability of CPOE and CDSS with automatic normalized dosing. 3. A comparison of the differences between the current state and future state weight-based medication ordering workflows. 4. A comparison of the different strategies for developing medication order sentences for children (weight-based dosing) and adults (standardized dosing).




School of Medicine



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