Effects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety

Medications are the most common treatment used in healthcare around the world. When used safely and appropriately, they contribute to significant improvements in the health and well-being of patients. Iatrogenic injuries related to medications are common, costly, and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) may reduce medication error rates. They have undergone several clinical trial methods.

Methods Adapted:

The researchers Rainu Kaushal, MD, MPH; Kaveh G. Shojania, MD; David W. Bates, MD, MSc, were identified clinical trials that evaluated the effects of Computerized physician order entry (CPOE) and clinical decision support systems (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 observational study with controls and if the measured outcomes were clinical (eg, adverse drug events) or surrogate (eg, medication errors) markers. Two reviewers extracted all the data. Discussion resolved any disagreements.

Five clinical trials for assessing computerized physician order entry (CPOE) and 7 assessing isolated clinical decision support systems CDSSs to meet the criteria. Of the CPOE studies, 2 studies were 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 nephrotoxic drug dose and frequency. From the 7 studies evaluating isolated CDSSs, 3 were demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events and 1 has improvement in theophylline-associated medication errors. The remaining 3 studies had non-significant results.

These studies provide evidence that the use of CPOE with CDSSs significantly decreases medication error and serious medication error rates at 2 institutions with "home-grown" systems. MEDICATION ERRORS and adverse drug events (ADEs) are common, costly, and clinically important problems.1-7 Each year, an estimated 770 000 people are injured or die in hospitals from ADEs, which are injuries resulting from drug use.Adult hospital incidence rates of ADEs have ranged from 2 to 7 per 100 admissions, although determination of a precise national estimate is difficult because studies have used varying definitions. Approximately 28% of ADEs are associated with a medication error and therefore are judged to be preventable Of preventable ADEs, 56% occurred during drug ordering.