Pediatric Informatics: Computer Applications in Child Health (Health ...

340 C.U. Lehmann and G.R. Kim
26.6 Pediatric-Related Organizational Issues
Pediatric care occurs in different institutional environments with varying levels of
pediatric expertise (prescribers, nursing, pharmacists). CPOE/CDS must be tailored
to fit the needs of the prescribers and the clinical workflow in specific environments
in which it operates. Organizational and cultural considerations in pediatric
CPOE/CDS adoption include:
The need for pediatric leadership and expertise: Pediatric care may be
only one of many competing priorities for a healthcare institution. Medical,
surgical, and psychiatric care of children in mixed settings (as may be present
in community hospitals) may increase the risks and impacts of medication
errors. Pediatricians must act as child advocates in this arena to raise attention
of hospital leadership to pediatric patient safety. Pediatricians must
also represent the needs of children in development of CPOE/CDS (and
other HIT).
The need to prioritize pediatric safety: CPOE/CDS adoption is part
of a holistic approach to reduce and prevent medication errors, which
includes:
� Establishing a child-centric patient safety culture
� Developing communication and shared staff awareness of pediatric care
�
Creating an active learning environment that educates staff about pediatric
needs and vulnerabilities and that facilitates error reporting 7
The global understanding that pediatric safety and HIT adoption
are continuous and iterative: Adoption of CPOE/CDS (or of any health
information technology) requires continuous monitoring and reevaluation
of the care process, in which it is embedded. Introduction changes work
relationships and may increase stress among staff. Ongoing measurement of
system and staff performance, of cultural climate, of errors and of outcomes
is needed to assure accurate and safe medication delivery to all pediatric
patients.
26.7 Conclusion
The adoption of inpatient CPOE (as with any technology) creates changes
within an error prone and complex process (prescribing and ordering of inpatient
medications). Pediatricians face technical and organizational challenges in
reaping the benefits of error reduction and increased safety for their patients,
but they also bring their ability to advocate for the needs of children. Adoption
of CPOE goes beyond the selection of a product and involves ongoing consideration
of present and future needs of children and the professionals who care
for them.