Transition to a new electronic health record and pediatric medication safety: lessons learned in pediatrics within a large academic health system

J Am Med Inform Assoc. 2018 Jul 1;25(7):848-854. doi: 10.1093/jamia/ocy034.


Objective: While the electronic health record (EHR) has become a standard of care, pediatric patients pose a unique set of risks in adult-oriented systems. We describe medication safety and implementation challenges and solutions in the pediatric population of a large academic center transitioning its EHR to Epic.

Methods: Examination of the roll-out of a new EHR in a mixed neonatal, pediatric and adult tertiary care center with staggered implementation. We followed the voluntarily reported medication error rate for the neonatal and pediatric subsets and specifically monitored the first 3 months after the roll-out of the new EHR. Data was reviewed and compiled by theme.

Results: After implementation, there was a 5-fold increase in the overall number of medication safety reports; by the third month the rate of reported medication errors had returned to baseline. The majority of reports were near misses. Three major safety themes arose: (1) enterprise logic in rounding of doses and dosing volumes; (2) ordering clinician seeing a concentration and product when ordering medications; and (3) the need for standardized dosing units through age contexts created issues with continuous infusions and pump library safeguards.

Conclusions: Future research and work need to be focused on standards and guidelines on implementing an EHR that encompasses all age contexts.

MeSH terms

  • Academic Medical Centers
  • Electronic Health Records*
  • Humans
  • Medical Order Entry Systems*
  • Medication Errors / prevention & control
  • Medication Errors / statistics & numerical data*
  • Near Miss, Healthcare / statistics & numerical data
  • Organizational Innovation*
  • Patient Safety
  • Pediatrics*