The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis

Abstract

BackgroundThe Health Information Technology for Economic and Clinical Health (HITECH) Act subsidizes implementation by hospitals of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries caused by medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, and effects on medication errors have been variable. The objectives of this analysis were to assess the effectiveness of CPOE at reducing pADEs in hospital-related settings, and examine reasons for heterogeneous effects on medication errors.MethodsArticles were identified using MEDLINE, Cochrane Library, Econlit, web-based databases, and bibliographies of previous systematic reviews (September 2013). Eligible studies compared CPOE with paper-order entry in acute care hospitals, and examined diverse pADEs or medication errors. Studies on children or with limited event-detection methods were excluded. Two investigators extracted data on events and factors potentially associated with effectiveness. We used random effects models to pool data.ResultsSixteen studies addressing medication errors met pooling criteria; six also addressed pADEs. Thirteen studies used pre-post designs. Compared with paper-order entry, CPOE was associated with half as many pADEs (pooled risk ratio (RR) = 0.47, 95% CI 0.31 to 0.71) and medication errors (RR = 0.46, 95% CI 0.35 to 0.60). Regarding reasons for heterogeneous effects on medication errors, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta-regression. Differences between commercial versus homegrown systems, presence and sophistication of clinical decision support, hospital-wide versus limited implementation, and US versus non-US studies were not significant, nor was timing of publication. Higher baseline rates of medication errors predicted greater reductions (P < 0.001). Other context and implementation variables were seldom reported.ConclusionsIn hospital-related settings, implementing CPOE is associated with a greater than 50% decline in pADEs, although the studies used weak designs. Decreases in medication errors are similar and robust to variations in important aspects of intervention design and context. This suggests that CPOE implementation, as subsidized under the HITECH Act, may benefit public health. More detailed reporting of the context and process of implementation could shed light on factors associated with greater effectiveness.

Dispensing errors and uncertainty: Perspectives of pharmacists in a tertiary health facility in Lagos, Nigeria

“…Respondents reported minimal use of technologies (Scale: 1.0), which serve as enabling tools in facilitating dispensing activities and minimizing errors. Researchers have shown that electronic health records (EHR), computerized prescription order entry (CPOE) technologies and e-pharmacy are very beneficial in error and cost minimization, dispensing high-alert medications, and improved patient outcomes; [39][40][41][42] while some reports show mixed benefits. [26,43] These technologies if made available in our practice setting would minimize errors and uncertainty, and enhance quality of care to the patients.…”

Physician satisfaction with transition from CPOE to paper-based prescription

“…Even if CPOE systems induce adverse events [31], the controversy about the overall helpful or harmful effect of CPOE [32] is now behind us [2][33] as CPOE implementation is now mandatory in France [34]. Stavri and Ash [13] suggested that success is often preceded by failure.…”

“…In theory, CPOE allows a reduction in duplicate medications, drug overdoses, contraindications, unconsidered allergies, etc [1]. In practice, it reduces preventable adverse drug events [2]. While implementation of CPOE in hospitals in the USA [3] [4] and in the Netherlands seems to be well underway, other countries lag far behind [5].…”

An environmental analysis of the evolution of readmission reduction strategies: A study of United States hospitals

“…Under this act, hospitals would obtain financial incentives if they used information technology (e.g., electronic health records) to improve quality, safety and efficiency of healthcare while engaging patients and their families in care. [40][41][42] The HITECH Act worked as a regulatory, technological and…”