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01.04.2008 | Clinical Review

The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review

verfasst von: Jesse I. Wolfstadt, Jerry H. Gurwitz, MD, Terry S. Field, DSc, Monica Lee, RPh, Sunila Kalkar, MBBS, MD, Wei Wu, MSc, Paula A. Rochon, MD, MPH

Erschienen in: Journal of General Internal Medicine | Ausgabe 4/2008

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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.

Poon EG, Blumenthal D, Jaggi T, Honour MM, Bates DW, Kaushal R. Overcoming barriers to adopting and implementing computerized physician order entry systems in U.S. hospitals. Health Aff. 2004;23:184–90.CrossRef

Kaushal R, Bates DW. Information technology and medication safety: what is the benefit? Qual Saf Health Care. 2002;11:261–5.PubMedCrossRef

Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003;163:1409–16.PubMedCrossRef

Rochon PA, Field TS, Bates DW, et al. Computerized physician order entry with clinical decision support in the long-term care setting: insights from the Baycrest Centre for Geriatric Care. J Am Geriatr Soc. 2005;53:1780–9.PubMedCrossRef

Kohn LT. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.

Fortescue EB, Kaushal R, Landrigan CP, et al. Prioritizing strategies for preventing medication errors and adverse drug events in pediatric inpatients. Pediatrics. 2003;111:722–9.PubMedCrossRef

Gurwitz JH, Field TS, Judge J, et al. The incidence of adverse drug events in two large academic long-term care facilities. Am J Med. 2005;118:251–8.PubMedCrossRef

Kuperman GJ, Bobb A, Payne TH, et al. Medication-related clinical decision support in computerized provider order entry systems: a review. J Am Med Inform Assoc. 2007;14:29–40.PubMedCrossRef

Gesteland PH, Nebeker JR, Gardner RM. These are the technologies that try men’s souls: common-sense health information technology. Pediatrics. 2006;117:216–7.PubMedCrossRef

10.

Sittig DF, Ash JS, Zhang J, Osheroff JA, Shabot MM. Lessons from “Unexpected increased mortality after implementation of a commercially sold computerized physician order entry system”. Pediatrics. 2006;118:797–801.PubMedCrossRef

11.

Jacobs BR, Brilli RJ, Hart KW. Perceived increase in mortality after process and policy changes implemented with computerized physician order entry. Pediatrics. 2006;117:1451–2.PubMedCrossRef

12.

Longhurst C, Sharek P, Hahn J, Sullivan J, Classen D. Perceived increase in mortality after process and policy changes implemented with computerized physician order entry. Pediatrics. 2006;117:1450–1.PubMedCrossRef

13.

Rosenbloom ST, Harrell FE Jr., Lehmann CU, Schneider JH, Spooner SA, Johnson KB. Perceived increase in mortality after process and policy changes implemented with computerized physician order entry. Pediatrics. 2006;117:1452–5.PubMedCrossRef

14.

Bates DW, Boyle DL, Vliet MVV, Schneider J, Leape L. Relationship between medication errors and adverse drug events. J Gen Intern Med. 1995;10:199–205.PubMedCrossRef

15.

Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. JAMA. 1995;274:29–34.PubMedCrossRef

16.

Gandhi TK, Weingart SN, Borus J, et al. Adverse drug events in ambulatory care. N Engl J Med. 2003;348:1556–64.PubMedCrossRef

17.

Gurwitz JH, Field TS, Harrold LR, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.PubMedCrossRef

18.

Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA. 1997;277:307–11.PubMedCrossRef

19.

Classen DC, Pestotnik SL, Evans RS, Lloyd JF, Burke JP. Adverse drug events in hospitalized patients. Excess length of stay, extra costs, and attributable mortality. JAMA. 1997;277:301–6.PubMedCrossRef

20.

Field TS, Gilman BH, Subramanian S, Fuller JC, Bates DW, Gurwitz JH. The costs associated with adverse drug events among older adults in the ambulatory setting. Med Care. 2005;43:1171–6.PubMedCrossRef

21.

Institute of Medicine. Preventing Medication Errors: Quality Chasm SeriesWashington, DC: National Academy Press; 2007.

22.

Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.PubMedCrossRef

23.

Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280:1311–6.PubMedCrossRef

24.

Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6:313–21.PubMed

25.

Colpaert K, Claus B, Somers A, Vandewoude K, Robays H, Decruyenaere J. Impact of computerized physician order entry on medication prescription errors in the intensive care unit: a controlled cross-sectional trial. Crit Care. 2006;10:R21.PubMedCrossRef

26.

Evans RS, Classen DC, Pestotnik SL, Clemmer TP, Weaver LK, Burke JP. A decision support tool for antibiotic therapy. Proceedings from the 19th Annual Symposium on Computer Applications in Medical Care. 1995:651–5.

27.

Evans RS, Pestotnik SL, Classen DC, et al. A computer-assisted management program for antibiotics and other antiinfective agents. N Engl J Med. 1998;338:232–8.PubMedCrossRef

28.

Evans RS, Pestotnik SL, Classen DC, Horn SD, Bass SB, Burke JP. Preventing adverse drug events in hospitalized patients. Ann Pharmacother. 1994;28:523–7.PubMed

29.

Mullett CJ, Evans RS, Christenson JC, Dean JM. Development and impact of a computerized pediatric antiinfective decision support program. Pediatrics. 2001;108:E75.PubMedCrossRef

30.

Peterson JF, Kuperman GJ, Shek C, Patel M, Avorn J, Bates DW. Guided prescription of psychotropic medications for geriatric inpatients. Arch Intern Med. 2005;165:802–7.PubMedCrossRef

31.

Steele AW, Eisert S, Witter J, et al. The effect of automated alerts on provider ordering behavior in an outpatient setting. PLoS Med. 2005;2:e255.PubMedCrossRef

32.

Upperman JS, Staley P, Friend K, et al. The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital. J Pediatr Surg. 2005;40:57–9.PubMedCrossRef

33.

Garg AX, Adhikari NK, McDonald H, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA. 2005;293:1223–38.PubMedCrossRef

34.

Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA. 1998;280:1339–46.PubMedCrossRef

35.

Donner A, Klar N. Design and Analysis of Cluster Randomization Trials in Health Research. New York: Oxford University Press; 2000.

36.

Rochon PA, Field TS, Bates DW, et al. Clinical application of a computerized system for physician order entry with clinical decision support to prevent adverse drug events in long-term care. CMAJ. 2006;174:52–4.PubMed

37.

Judge J, Field TS, Deflorio M, et al. Prescribers’ responses to alerts during medication ordering in the long term care setting. J Am Med Inform Assoc. 2006;13:385–90.PubMedCrossRef

38.

Ganjavi H, Herrmann N, Rochon PA, et al. Adverse drug events in cognitively impaired elderly patients. Dement Geriatr Cogn Disord. 2007;23:395–400.CrossRef

39.

Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30(2)239–45.PubMedCrossRef

Titel: The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review
verfasst von: Jesse I. Wolfstadt
Jerry H. Gurwitz, MD
Terry S. Field, DSc
Monica Lee, RPh
Sunila Kalkar, MBBS, MD
Wei Wu, MSc
Paula A. Rochon, MD, MPH
Publikationsdatum: 01.04.2008
Verlag: Springer-Verlag
Erschienen in: Journal of General Internal Medicine / Ausgabe 4/2008
Print ISSN: 0884-8734
Elektronische ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-008-0504-5

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The Effect of Computerized Physician Order Entry with Clinical Decision Support on the Rates of Adverse Drug Events: A Systematic Review