Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review

• HIT Description: Computerized physician order entry (CPOE) and clinical decision support systems More info...
  
• Purpose of Study: Assess the effect of CPOE and CDSSs on medication error.
  
• Years of study: Not Available
  
• Study Design: Systematic review
  
• Outcomes: Adverse drug events, medication errors, prescribing behaviors
  

• Evaluation Method: We identified trials that evaluate the effects of CPOE and CDSSs on medication safety by electronically searching MEDLINE and the Cochrane Library and by manually searching the bibliographies of retrieved articles. Studies were included for systematic review if the design was a randomized controlled trial, a nonrandomized controlled trial, or an observation study with controls and if the measured outcomes were clinical (eg, adverse drug events) or surrogate (ed, mediation errors) markers. Two reviewers extracted all the data. Discussion resolved any disagreements.
• Clinical Outcomes: Five trials assessing CPOE and 7 assessing isolated CDSSs met the criteria. Of the CPOE studies, 2 demonstrated a marked decrease in the serious medication error rate, 1 an improvement in corollary orders, 1 an improvement in 5 prescribing behaviors, and 1 an improvement in nephorotoxic drug dose and frequency. Of the 7 studies evaluating isolated CDSSs, 3 demonstrated statistically significant improvement in antibiotic associated medication errors or adverse drug events and 1 an improvement in theophylline-associated medication errors. The remaining 3 studies had nonsignificant results.
• Conclusion: Use of CPOE and isolated CDSSs can substantially reduce medication error rates, but most studies have not been powered to detect differences in adverse drug events and have evaluated a small number of Òhomegrown' systems. Research is needed to evaluate commercial systems, to compare the various applications, to identify key components of applications, and to identify factors related to successful implementation of these systems.