The Effect of Computerized Physician Order Entry and Decision Support System on Medication Errors in the Neonatal Ward: Experiences from an Iranian Teaching Hospital

Objective: An adverse drug event (ADE) is an injury resulting from a medical intervention related to a drug. The emergency department (ED) is a ward vulnerable to more ADEs because of overcrowding. Information technologies such as computerized physician order entry (CPOE) and clinical decision support system (CDSS) may decrease the occurrence of ADEs. This study aims to review research that reported the evaluation of the effectiveness of CPOE and CDSS on lowering the occurrence of ADEs in the ED. Data Sources: PubMed, EMBASE, and Web of Science databases were used to find studies published from 2003 to 2018. The search was conducted in November 2018. Study Selection and Data Extraction: The search resulted in 1700 retrieved articles. After applying inclusion and exclusion criteria, 11 articles were included. Data on the date, country, type of system, medication process stages, study design, participants, sample size, and outcomes were extracted. Data Synthesis: Results showed that CPOE and CDSS may prevent ADEs in the ED through significantly decreasing the rate of errors, ADEs, excessive dose, and inappropriate prescribing (in 54.5% of articles); furthermore, CPOE and CDSS may significantly increase the rate of appropriate prescribing and dosing in compliance with established guidelines (45.5% of articles). Conclusion: This study revealed that the use of CPOE and CDSS can lower the occurrence of ADEs in the ED; however, further randomized controlled trials are needed to address the effect of a CDSS, with basic or advanced features, on the occurrence of ADEs in the ED.

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Verhindern von unerwünschten Arzneimittelereignissen mit Hilfe von elektronischen Entscheidungsunterstützungssystemen

Therapeutische Umschau ◽

10.1024/0040-5930/a000739 ◽

2015 ◽

Vol 72 (11/12) ◽

pp. 693-700

Author(s):

Ali Reza Salili ◽

Felix Hammann ◽

Anne B. Taegtmeyer

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Clinical Decision ◽

Computerized Physician Order Entry ◽

Order Entry ◽

Computerized Provider Order Entry ◽

Unerwünschte Arzneimittelereignisse ◽

Physician Order Entry

Zusammenfassung. Unerwünschte Arzneimittelereignisse sind ein grosses Risiko für Patienten und ein alltägliches klinisches Problem mit potentiellen Haftungsfolgen. CPOE-Systeme („Computerized Physician Order Entry“ bzw. „Computerized Provider Order Entry“-Systeme) in Kombination mit elektronischen Systemen zur klinischen Entscheidungsunterstützung („Clinical Decision Support System“ = „CDSS“) sind im Trend und zielen nicht nur auf die Reduktion von Verordnungsfehlern, sondern ermöglichen eine rasche Reaktion auf potentiell vermeidbare Arzneimittelinteraktionen. Der effektive Nutzen solcher Systeme ist aber bis dato noch nicht definitiv geklärt. Dieser Artikel fokussiert auf den aktuellen Stand der Entwicklung von CPOE-/CDS-Systemen, deren Nutzen und Risiken, Zukunftsperspektiven und Verbesserungsmöglichkeiten.

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National trends in safety performance of electronic health record systems in children’s hospitals

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocw134 ◽

2017 ◽

Vol 24 (2) ◽

pp. 268-274 ◽

Cited By ~ 7

Author(s):

Juan D Chaparro ◽

David C Classen ◽

Melissa Danforth ◽

David C Stockwell ◽

Christopher A Longhurst

Keyword(s):

Decision Support ◽

Electronic Health Record ◽

Medication Errors ◽

Computerized Physician Order Entry ◽

Health Record ◽

Evaluation Tool ◽

Order Entry ◽

Initial Testing ◽

Pediatric Hospitals ◽

Physician Order Entry

Objective: To evaluate the safety of computerized physician order entry (CPOE) and associated clinical decision support (CDS) systems in electronic health record (EHR) systems at pediatric inpatient facilities in the US using the Leapfrog Group’s pediatric CPOE evaluation tool. Methods: The Leapfrog pediatric CPOE evaluation tool, a previously validated tool to assess the ability of a CPOE system to identify orders that could potentially lead to patient harm, was used to evaluate 41 pediatric hospitals over a 2-year period. Evaluation of the last available test for each institution was performed, assessing performance overall as well as by decision support category (eg, drug-drug, dosing limits). Longitudinal analysis of test performance was also carried out to assess the impact of testing and the overall trend of CPOE performance in pediatric hospitals. Results: Pediatric CPOE systems were able to identify 62% of potential medication errors in the test scenarios, but ranged widely from 23–91% in the institutions tested. The highest scoring categories included drug-allergy interactions, dosing limits (both daily and cumulative), and inappropriate routes of administration. We found that hospitals with longer periods since their CPOE implementation did not have better scores upon initial testing, but after initial testing there was a consistent improvement in testing scores of 4 percentage points per year. Conclusions: Pediatric computerized physician order entry (CPOE) systems on average are able to intercept a majority of potential medication errors, but vary widely among implementations. Prospective and repeated testing using the Leapfrog Group’s evaluation tool is associated with improved ability to intercept potential medication errors.

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