Computerized Physician Order Entry and Pediatric Prescribing Errors: A Multicenter Database Study.

PURPOSE: To compare dosing error rates between computerized physician order entry (CPOE) and free-text electronic prescribing in hospitalized children during the same time period, given inconsistent evidence regarding the effectiveness of CPOE in pediatric settings. PATIENTS AND METHODS: We conducted a retrospective multicenter cohort study across four Israeli general hospitals between July 1, 2022, and December 31, 2023. A computerized algorithm analyzed the ten most frequently administered systemic medications and flagged potential dosing errors defined as a ≥20% deviation from weight-based recommendations. All flagged prescriptions underwent blinded independent review by a senior pediatrician with toxicology expertise and a pediatric clinical pharmacist to confirm clinical significance. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs). RESULTS: Of 122,869 medication orders for 63,081 children, the confirmed error rate was 3.6%. In unadjusted analyses, dosing errors were more frequent with CPOE than with manual prescribing (3.8% vs 2.8%; p<0.001). After adjustment, CPOE was not associated with a significant overall difference in error risk (aOR 0.98; 95% confidence interval [CI] 0.88-1.09). In the enteral-only analysis, CPOE was associated with a 33% higher risk of errors in enteral medications (aOR 1.33; 95% CI 1.18-1.51; p<0.001). Error risk also varied by hospital site, patient weight, care setting, and administration route. CONCLUSION: In real-world pediatric settings, CPOE was not associated with a lower overall incidence of dosing errors, and higher error rates were observed among enteral medications. These results suggest that CPOE may introduce route-specific vulnerabilities, highlighting the need for system-specific optimization rather than assuming electronic ordering is inherently safer.