Nadia Roumeliotis1,2, Jonathan Sniderman3, Thomasin Adams-Webber4, Newton Addo5, Vijay Anand6, Paula Rochon7, Anna Taddio8, Christopher Parshuram3,8. 1. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. nadia.roumeliotis@gmail.com. 2. Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, Canada. nadia.roumeliotis@gmail.com. 3. Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 4. Library & Archives Services, The Hospital for Sick Children, Toronto, ON, Canada. 5. Division of Clinical Pharmacology, Department of Medicine, UCSF, San Francisco, CA, USA. 6. Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, Canada. 7. Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada. 8. Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, Canada.
Abstract
BACKGROUND: Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medication errors and patient harm in hospitalized patients. METHODS: MEDLINE, EMBASE, CENTRAL, and CINAHL were searched from January 2007 to January 2018. We included prospective studies that compared hospital-based electronic prescribing strategies with control, and reported on medication error or patient harm. Data were abstracted by two reviewers and pooled using random effects model. Study quality was assessed using the Effective Practice and Organisation of Care and evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Thirty-eight studies were included; comprised of 11 randomized control trials and 27 non-randomized interventional studies. Electronic prescribing strategies reduced medication errors (RR 0.24 (95% CI 0.13, 0.46), I2 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I2 96%, n = 9), with both risk ratios significantly affected by advancing year of publication. There was a significant effect of electronic prescribing strategies on adverse drug events (ADEs) (RR 0.52 (95% CI 0.40, 0.68), I2 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I2 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62-1.70), I2 28%, n = 7), length of stay (MD - 0.18 (95% - 1.42, 1.05), I2 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I2 74%, n = 9). The quality of evidence was rated very low. DISCUSSION: Electronic prescribing strategies decrease medication errors and adverse drug events, but had no effect on other patient outcomes. Conservative interpretations of these findings are supported by significant heterogeneity and the preponderance of low-quality studies.
BACKGROUND: Computerized physician order entry and clinical decision support systems are electronic prescribing strategies that are increasingly used to improve patient safety. Previous reviews show limited effect on patient outcomes. Our objective was to assess the impact of electronic prescribing strategies on medication errors and patient harm in hospitalized patients. METHODS: MEDLINE, EMBASE, CENTRAL, and CINAHL were searched from January 2007 to January 2018. We included prospective studies that compared hospital-based electronic prescribing strategies with control, and reported on medication error or patient harm. Data were abstracted by two reviewers and pooled using random effects model. Study quality was assessed using the Effective Practice and Organisation of Care and evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation. RESULTS: Thirty-eight studies were included; comprised of 11 randomized control trials and 27 non-randomized interventional studies. Electronic prescribing strategies reduced medication errors (RR 0.24 (95% CI 0.13, 0.46), I2 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I2 96%, n = 9), with both risk ratios significantly affected by advancing year of publication. There was a significant effect of electronic prescribing strategies on adverse drug events (ADEs) (RR 0.52 (95% CI 0.40, 0.68), I2 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I2 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62-1.70), I2 28%, n = 7), length of stay (MD - 0.18 (95% - 1.42, 1.05), I2 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I2 74%, n = 9). The quality of evidence was rated very low. DISCUSSION: Electronic prescribing strategies decrease medication errors and adverse drug events, but had no effect on other patient outcomes. Conservative interpretations of these findings are supported by significant heterogeneity and the preponderance of low-quality studies.
Authors: Antonio Oliva; Gerardo Altamura; Mario Cesare Nurchis; Massimo Zedda; Giorgio Sessa; Francesca Cazzato; Giovanni Aulino; Martina Sapienza; Maria Teresa Riccardi; Gabriele Della Morte; Matteo Caputo; Simone Grassi; Gianfranco Damiani Journal: BMJ Open Date: 2022-05-17 Impact factor: 3.006
Authors: Greet Van De Sijpe; Charlotte Quintens; Karolien Walgraeve; Eva Van Laer; Jens Penny; Greet De Vlieger; Rik Schrijvers; Paul De Munter; Veerle Foulon; Minne Casteels; Lorenz Van der Linden; Isabel Spriet Journal: BMC Med Inform Decis Mak Date: 2022-02-22 Impact factor: 2.796