Increased mortality after drug entry system installed

Researchers in the US have found a surprise rise in the mortality rates in a children’s hospital since the implementation of a software system designed to reduce adverse drug effects.

The computerised physician order entry system (CPOE) was installed over a period of six days in the Children’s Hospital in Pittsburgh. The study was undertaken during an eighteen month period before and after the system was put in place. Researchers at the University of Pittsburgh found that the unadjusted mortality rate rose from 2.8%, before the installation, to 6.57% afterwards.

Possible reasons for the unexpected increase given by researchers include the increased amount of time needed to administer drugs through the system, the time spent by nurses away from patients at the computer and the centralisation of the pharmacy services.

"Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies," recommends the study.

Researchers expressed surprise and concern at the apparent rise in mortality rates, while noting that so far "no study has actually reported a direct association between CPOE and reduced mortality". The increase in mortality was despite the system successfully reducing the number of adverse drug effects in the hospital.

The CPOE system in question, from Cerner, was installed in the hospital in October 2002, and was designed to offer decision support and warnings of contraindications to doctors ordering drugs. Users securely log in, identify the patient, input all drug information (dose, frequency, administration method and length of treatment) and the system checks the order and sends it to a nurse to be activated before it reaches the pharmacy.

Mortality rates were found to have increased most in those patients who had been transferred to the hospital from elsewhere, and those in intensive care. The study suggested that the extra time needed for entering data into the system and waiting for approval may not have mattered in a general ward but could "have significant patient care consequences" in intensive care.

"The interactions between ICU team members have remained fundamentally altered," say the researchers, adding that before the system was put in place, antibiotics and other drugs were generally given to patients within government-approved targets. "After CPOE implementation, we have found that fewer than half of the patients received critical antibiotics and vasoactive infusions within these timelines."

Each member of staff was trained in the use of the system over a period of three months before implementation, by way of a compulsory three-hour training session, the study stressed.

The study is published in the latest issue of Pediatrics, the official journal of the American Academy of Pediatrics.

Links

Abstract of article at Pediatrics

Discussion of article on HISTalk blog