The American Recovery and Reinvestment Act subsidizes hospitals’ implementation of electronic health records with computerized provider order entry (CPOE), which may reduce patient injuries due to medication errors (preventable adverse drug events, pADEs). Effects on pADEs have not been rigorously quantified, while effects on medication errors (MEs), an intermediate outcome, have been variable. The objectives of this analysis were to assess CPOE’s effectiveness at reducing pADEs in hospital‐related settings, and examine reasons for heterogeneity in effects on MEs.
Articles were identified using MEDLINE, Cochrane library, Econlit, web‐based databases, and bibliographies of 33 systematic reviews (September 2013). Eligible studies compared CPOE with paper‐order entry; examined various types of pADEs or MEs; and were set in acute‐care hospitals. Studies on children or with limited event detection methods were excluded. Two investigators extracted data on pADEs and MEs as well as factors potentially associated with effectiveness. We used random effects models to pool data.
16 studies addressing MEs met eligibility and 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 0.31‐0.71) and MEs (RR 0.46, 95%‐CI 0.35‐0.60). Regarding reasons for heterogeneity in effects on MEs, five intervention factors and two contextual factors were sufficiently reported to support subgroup analyses or meta‐regression. Differences between commercial vs. home‐grown systems, type of clinical decision support (present vs. absent, and basic vs. moderate or advanced), hospital‐wide vs. limited implementation, and U.S. vs. non‐U.S. studies were not significant, as was timing of publication. Higher baseline rates of MEs predicted greater reductions (p<0.001).
In hospital‐related settings, implementing CPOE is associated with >50% decline in pADEs. Decreases in MEs are similar and robust to variations in important aspects of intervention design and context.
To cite this abstract:Nuckols T. 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 published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 698. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/the-effectiveness-of-computerized-order-entry-at-reducing-preventable-adverse-drug-events-and-medication-errors-in-hospital-settings-a-systematic-review-and-metaanalysis/. Accessed May 26, 2019.