Response to Medication Dosing Alerts for Pediatric Inpatients Using a Computerized Provider Order Entry System

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This is a review of Perlman S.L., Fabrizio L., Shaha S.H., & Magid S.K. 2011 article, “Response to Medication Dosing Alerts for Pediatric Inpatients Using a Computerized Provider Order Entry System”.[1]


This article pertains to a study that was done to evaluate provider response to the dosing alerts in a Computerized provider order entry (CPOE) system with an integrated Clinical Decision Support (CDS) system for pediatric inpatients. The authors also wanted to identify the differences in provider response based on clinician specialty. They were interested in differences between pediatric trained providers such as pediatricians, pediatric anesthesiologist, pediatric rheumatologists and providers without specific training such as orthopedic surgeons, residents, surgical physician assistants, and anesthesiologist. The authors also stressed that avoidance of medication dosing errors is essential to improved quality of care and also increased patient safety.


A retrospective study took place at Hospital for Special Surgery (HSS) in which analyzed all medication dosing alerts over a one year period. It started from January 1 – December 31, 2008 and applied to all pediatric inpatients at HSS. The CPOE system that was used was the inpatient clinical information systemclinical information system (CIS) Sunrise Clinical Manager. Authors also noted that CDS was a major component of CIS and contains features such as dose range checking, drug-drug interactions, allergy alerts, and duplicate medication order alerts. Medication dosing alerts were analyzed for patients younger than 18 years of age and a report was made to include all pediatric admissions, the number of medication orders placed for each patient and if a medication dosing alert was enabled on a particular order. The alerts were analyzed by medication dosing, prescriber, and action taken by the prescriber after the alert was triggered.

Results and Discussion

As a result from the data collected there were 18,163 medication orders placed and 1,024 dosing alerts that were triggered during the study. They also found that overdosing of medications accounted for 91% of the alerts while underdosing was at 9%. As far as finding the differences between pediatric specialist and non-pediatric specialist the pediatric-trained providers were found to ignore more alerts and cancelled fewer orders. Both groups changed their order due to the CDS feature in which was enabled.


This article serves as a good reference point in finding how CPOE’s and CDS can both provide information in regards to how physicians use these systems. Integrating a CDS within a CPOE will enhance the system and aide physicians when trying to prevent adverse drug reactions and adverse drug events. Also understanding the various roles and individuals involved with using a CPOE will create room for improvements in regards to system customization for specific roles and environments.


  1. Perlman, S. L., Fabrizio, L., Shaha, S. H., & Magid, S. K. (2011). Response to medication dosing alerts for pediatric inpatients using a computerized provider order entry system. Appl Clin Inform., 2(4), 522-533. doi: 10.4338/ACI-2011-06-RA-0041 Retrieved from: