Difference between revisions of "Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review"
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== Background == | == Background == | ||
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[[Adverse drug event |adverse drug events (ADEs)]] is a major cause of death among medical errors associated deaths in both inpatient and outpatient settings. According to IOM, there are approximately 44,000-98,000 medical errors-linked deaths in the hospitalized patients in the US each year. [[Computerized physician order entry | computerized physician order entry (CPOE)]] combined with [[Clinical decision support systems | clinical decision support system (CDSS)]] can presumably prevent occurrences of ADEs and related severe consequences. However, it remains elusive in practice in a real-world environment. This review article intended to summarize published results by means of systematic and narrative reviews dated back from 2008 to 2012 <ref name=" Ranji 2014"> Ranji, S. R., Rennke, S., & Wachter, R. M. (2014). Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Quality & Safety, 23(9), 773–780. http://doi.org/10.1136/bmjqs-2013-002165.</ref>. | [[Adverse drug event |adverse drug events (ADEs)]] is a major cause of death among medical errors associated deaths in both inpatient and outpatient settings. According to IOM, there are approximately 44,000-98,000 medical errors-linked deaths in the hospitalized patients in the US each year. [[Computerized physician order entry | computerized physician order entry (CPOE)]] combined with [[Clinical decision support systems | clinical decision support system (CDSS)]] can presumably prevent occurrences of ADEs and related severe consequences. However, it remains elusive in practice in a real-world environment. This review article intended to summarize published results by means of systematic and narrative reviews dated back from 2008 to 2012 <ref name=" Ranji 2014"> Ranji, S. R., Rennke, S., & Wachter, R. M. (2014). Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Quality & Safety, 23(9), 773–780. http://doi.org/10.1136/bmjqs-2013-002165.</ref>. | ||
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== Methods == | == Methods == | ||
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Systematic and Narrative reviews based on the following creteria<ref name=" Ranji 2014"> </ref>: | Systematic and Narrative reviews based on the following creteria<ref name=" Ranji 2014"> </ref>: | ||
* The specialized database from [[Agency for Healthcare Research and Quality (AHRQ) | Agency for Healthcare Research and Quality (AHRQ) ]] Patient Safety Net. | * The specialized database from [[Agency for Healthcare Research and Quality (AHRQ) | Agency for Healthcare Research and Quality (AHRQ) ]] Patient Safety Net. | ||
*Key words: [[Computerized physician order entry | computerized physician order entry (CPOE)]], [[Clinical decision support systems | clinical decision support system (CDSS)]], [[Adverse drug event |adverse drug events (ADEs)]]. | *Key words: [[Computerized physician order entry | computerized physician order entry (CPOE)]], [[Clinical decision support systems | clinical decision support system (CDSS)]], [[Adverse drug event |adverse drug events (ADEs)]]. | ||
*Literature: published between 2008 and 2012. | *Literature: published between 2008 and 2012. | ||
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== Results == | == Results == | ||
===Covered results=== | ===Covered results=== | ||
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*Five systematic reviews. | *Five systematic reviews. | ||
*One narrative review. | *One narrative review. | ||
*Two controlled trials. | *Two controlled trials. | ||
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===Summary=== | ===Summary=== | ||
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*The majority of data is derived from in-house developed systems: | *The majority of data is derived from in-house developed systems: | ||
#CPOE+CDSS: reduces prescribing errors consistently in the inpatient setting. | #CPOE+CDSS: reduces prescribing errors consistently in the inpatient setting. | ||
#CPOE+CDSS: no effects on prevention of ADEs in either the inpatient or outpatient setting. | #CPOE+CDSS: no effects on prevention of ADEs in either the inpatient or outpatient setting. | ||
#CPOE+CDSS: Profoundly changes clinician workflow and subsequently introduces unintended adverse consequences such alert fatigue. | #CPOE+CDSS: Profoundly changes clinician workflow and subsequently introduces unintended adverse consequences such alert fatigue. | ||
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== Conclusions == | == Conclusions == | ||
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*Unfortunately, CPOE+CDSS do not convincingly reduce or prevent ADEs, despite over a decade of widespread adoption and implementation. | *Unfortunately, CPOE+CDSS do not convincingly reduce or prevent ADEs, despite over a decade of widespread adoption and implementation. | ||
*More work needs to be done in the area in order to approach the pre-defined goal. | *More work needs to be done in the area in order to approach the pre-defined goal. | ||
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== Comments == | == Comments == | ||
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Although the results and conclusion do not seemly support the concept of ADE prevention by combination of CPOE and CDSS, the reasons behind these consequences may or may not really be due to the failures of CPOE+CDSS. For example, inappropriate installation and staff training could result in the failure of implementation. Therefore, it is still too early to draw a conclusion in terms of usefulness of CPOE with CDSS in the prevention of ADEs. | Although the results and conclusion do not seemly support the concept of ADE prevention by combination of CPOE and CDSS, the reasons behind these consequences may or may not really be due to the failures of CPOE+CDSS. For example, inappropriate installation and staff training could result in the failure of implementation. Therefore, it is still too early to draw a conclusion in terms of usefulness of CPOE with CDSS in the prevention of ADEs. | ||
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==References== | ==References== | ||
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<references/> | <references/> | ||
[[Category: Reviews]] | [[Category: Reviews]] | ||
Revision as of 05:10, 11 November 2015
Contents
Background
adverse drug events (ADEs) is a major cause of death among medical errors associated deaths in both inpatient and outpatient settings. According to IOM, there are approximately 44,000-98,000 medical errors-linked deaths in the hospitalized patients in the US each year. computerized physician order entry (CPOE) combined with clinical decision support system (CDSS) can presumably prevent occurrences of ADEs and related severe consequences. However, it remains elusive in practice in a real-world environment. This review article intended to summarize published results by means of systematic and narrative reviews dated back from 2008 to 2012 [1].
Methods
Systematic and Narrative reviews based on the following creteria[1]:
- The specialized database from Agency for Healthcare Research and Quality (AHRQ) Patient Safety Net.
- Key words: computerized physician order entry (CPOE), clinical decision support system (CDSS), adverse drug events (ADEs).
- Literature: published between 2008 and 2012.
Results
Covered results
- Five systematic reviews.
- One narrative review.
- Two controlled trials.
Summary
- The majority of data is derived from in-house developed systems:
- CPOE+CDSS: reduces prescribing errors consistently in the inpatient setting.
- CPOE+CDSS: no effects on prevention of ADEs in either the inpatient or outpatient setting.
- CPOE+CDSS: Profoundly changes clinician workflow and subsequently introduces unintended adverse consequences such alert fatigue.
Conclusions
- Unfortunately, CPOE+CDSS do not convincingly reduce or prevent ADEs, despite over a decade of widespread adoption and implementation.
- More work needs to be done in the area in order to approach the pre-defined goal.
Comments
Although the results and conclusion do not seemly support the concept of ADE prevention by combination of CPOE and CDSS, the reasons behind these consequences may or may not really be due to the failures of CPOE+CDSS. For example, inappropriate installation and staff training could result in the failure of implementation. Therefore, it is still too early to draw a conclusion in terms of usefulness of CPOE with CDSS in the prevention of ADEs.
References
- ↑ 1.0 1.1 Ranji, S. R., Rennke, S., & Wachter, R. M. (2014). Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Quality & Safety, 23(9), 773–780. http://doi.org/10.1136/bmjqs-2013-002165.
