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

From Clinfowiki
Revision as of 00:45, 5 March 2015 by Eelms (Talk | contribs)

Jump to: navigation, search

Background

Clinical Decision Support (CDS) and Computerized Physician Order Entry (CPOE) are believed to reduce medication errors and adverse drug events (ADEs) when integrated in EHR systems.

Research Questions

One important question from the authors was “whether the currently available data were sufficiently compelling that CPOE should be widely adopted or whether further research was required.”

Methods

The authors used the U.S. National Library of Medicine, Medline electronic bibliographic database and the electronic Cochran library for their literature search. They identified and evaluated articles that described computerized systems for performing general order entry or CDS systems for guiding physicians in the order-writing process. All articles identified were grouped into two categories. One category evaluated CPOE with CDS systems while the other evaluated CDS systems alone.

Results

The category of articles that evaluated CPOE with CDS systems showed 25 percent improvement in ordering, 55-86 percent decrease in medication errors, 13 percent decrease in inappropriate dose, 24 percent decrease in inappropriate frequency, and improvement in prescribing practices. The category of studies that evaluated isolated CDS systems showed a decrease in ADEs, lower rates of drug toxicity and fewer interventions.

Conclusion

The studies evaluated in this systematic review provide some evidence that medication errors and serious medication error rates are significantly decreased with the use of CPOE and CDS systems. Although the effect of ADE rates has not been adequately tested, considering the strong correlation between medication errors and ADEs, the use of CPOE and CDS systems also appears to have the propensity to decrease ADEs.

Discussion

A great number of injuries are caused by medication errors and ADEs. The primary driving force behind the adoption of CPOE and CDS systems is patient safety and better clinical outcomes. It has been shown that the use of CPOE and isolated CDS systems significantly decreases medication error rates and provides other important benefits related to medication use. Many barriers to CPOE adoption exist, and these barriers have made organizational adoption to CPOE very limited. The authors believe that further studies are needed to clarify a few unanswered questions in order to promote the widespread adoption of CPOE. In addition, more investigation is needed with regard to the efficacy of individual CDS elements.

References

http://archinte.jamanetwork.com/article.aspx?articleid=215756