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Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis
- Source :
- J Gen Intern Med, Journal of general internal medicine, vol 34, iss 10
- Publication Year :
- 2019
-
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.
- 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
Subjects
Details
- ISSN :
- 15251497
- Volume :
- 34
- Issue :
- 10
- Database :
- OpenAIRE
- Journal :
- Journal of general internal medicine
- Accession number :
- edsair.doi.dedup.....d1e6d0d0f2a5594bd87f560b4f04bdc8