1. Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis
- Author
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Nadia Roumeliotis, V. Anand, Paula A. Rochon, Anna Taddio, Christopher S. Parshuram, Thomasin Adams-Webber, Jonathan Sniderman, and Newton Addo
- Subjects
medicine.medical_specialty ,Outcome Assessment ,Drug-Related Side Effects and Adverse Reactions ,medication error ,Clinical Trials and Supportive Activities ,Clinical Sciences ,MEDLINE ,Decision Support Systems ,Review Article ,01 natural sciences ,law.invention ,7.3 Management and decision making ,03 medical and health sciences ,Patient safety ,Clinical ,Electronic Prescribing ,0302 clinical medicine ,Randomized controlled trial ,Computerized physician order entry ,law ,Clinical Research ,Electronic prescribing ,General & Internal Medicine ,Outcome Assessment, Health Care ,Internal Medicine ,Medicine ,Humans ,Medication Errors ,030212 general & internal medicine ,0101 mathematics ,Prospective cohort study ,Randomized Controlled Trials as Topic ,electronic prescribing ,business.industry ,010102 general mathematics ,Decision Support Systems, Clinical ,preventable adverse drug events ,Health Care ,Good Health and Well Being ,Meta-analysis ,Relative risk ,Emergency medicine ,Patient Safety ,Management of diseases and conditions ,CDSS ,business ,CPOE - 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), I(2) 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I(2) 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), I(2) 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I(2) 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62–1.70), I(2) 28%, n = 7), length of stay (MD − 0.18 (95% − 1.42, 1.05), I(2) 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I(2) 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s11606-019-05236-8) contains supplementary material, which is available to authorized users.
- Published
- 2019