Wolfstadt JI et al. 2008 "The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review."
Reference
Wolfstadt JI, Gurwitz JH, Field TS, et al. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: a systematic review. J Gen Intern Med 2008;23(4):451-458.
Abstract
"CONTEXT: Computerized physician order entry (CPOE) with clinical decision support (CDS) has been promoted as an effective strategy to prevent the development of a drug injury defined as an adverse drug event (ADE). OBJECTIVE: To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure. DATA SOURCES: PUBMED versions of MEDLINE (from inception through March 2007) were searched to identify relevant studies. Reference lists of included studies were also searched. METHODS: We searched for original investigations, randomized and nonrandomized clinical trials, and observational studies that evaluated the effect of CPOE with CDS on the rates of ADEs. The studies identified were assessed to determine the type of computer system used, drug categories being evaluated, types of ADEs measured, and clinical outcomes assessed. RESULTS: Of the 543 citations identified, 10 studies met our inclusion criteria. These studies were grouped into categories based on their setting: hospital or ambulatory; no studies related to the long-term care setting were identified. CPOE with CDS contributed to a statistically significant (P <=.05) decrease in ADEs in 5 (50.0%) of the 10 studies. Four studies (40.0%) reported a nonstatistically significant reduction in ADE rates, and 1 study (10.0%) demonstrated no change in ADE rates. CONCLUSIONS: Few studies have measured the effect of CPOE with CDS on the rates of ADEs, and none were randomized controlled trials. Further research is needed to evaluate the efficacy of CPOE with CDS across the various clinical settings."
Objective
"To systematically review studies evaluating the effects of CPOE with CDS on the development of an ADE as an outcome measure."
Size
not applicable
Other Information
Of the ten studies included in the review, "Nine were performed in hospital settings [and] one study was performed in the ambulatory care setting."
Type of Health IT
Decision support system
Type of Health IT Functions
"CPOE linked with CDS has been promoted as having great potential for reducing medication errors and adverse drug events (ADEs). Clinical decision support can provide either basic (e.g., drug-allergy checking) or advanced (e.g., drug dosing support for renal insufficiency) guidance to the prescriber... Basic medication-related decision supports include drug-allergy checking, basic dosing guidance, formulary decision support, duplicate therapy checking, and drug-drug interaction checking. Advanced medication-related decision supports include dosing support for renal insufficiency and geriatric patients, guidance for medication-related laboratory testing, drug-pregnancy checking, and drug-disease contraindication checking."
Workflow-Related Findings
The authors found, "that 70% of the studies evaluating the rates of ADEs used homegrown CPOE with CDS systems. Customization is required to make a CPOE with CDS system work for a specific environment. Accordingly, it is understandable that most of the systems evaluated in [the] study were homegrown. A successful system often requires input from all of the staff members who will use the system (e.g., nurses, physicians, and pharmacists) and can take years to develop."
"Five of the 10 studies reported a statistically significant (P<.05) reduction in the number of ADEs through the use of CPOE with CDS. Another 4 studies showed a trend towards a reduction in the rate of ADEs with CPOE and CDS, but these did not achieve statistical significance. Only 1 study reported no effect on the number of ADEs when a CPOE with
CDS was implemented."
CDS was implemented."
Study Design
Systematic literature review
Study Participants
"A total of 543 citations were identified for further review by two of [the authors]. A total of 7 original investigations were identified for inclusion [then the authors] searched the reference list of these 7 original investigations and identified 3 additional studies meeting [their] criteria."