Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: A Systematic Review and meta-analysis
CCCF ePoster library. Roumeliotis N. Nov 7, 2018; 233424
Dr. Nadia Roumeliotis
Dr. Nadia Roumeliotis
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Abstract
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Background: Computerized Physician Order Entry (CPOE) and Clinical Decision Support Systems (CDSS) are electronic prescribing strategies that are increasingly used to improve patient safety. Despite evidence for improvement in prescribing practice, previous reviews have shown a limited effect on patient outcomes. 

Objectives: To assess the impact of electronic prescribing strategies on medication errors and patient harm in hospitalized patients.

Methods: This study was conducted according to PRISMA guidelines and is registered with PROSPERO. The data sources MEDLINE, EMBASE, CINAHL and PsycINFO were searched from January 1st 2007 to January 1s t2018. We selected English language prospective studies that compared hospital-based electronic prescribing strategies to control, and reported on the outcomes of medication error or patient harm, including adverse drug events (ADEs), hypoglycemia, length of stay, and mortality. Data were abstracted by two reviewers. Study quality was assessed using the Effective Practice and Organisation of Care (EPOC) and evidence quality was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Data were pooled using a random effects model and plotted with forest plots.

Results: Thirty-eight studies were comprised of 11 randomized control trials (RCTs) and 27 non-randomized interventional studies (NRIS). Medication error was reported in 13 studies and patient outcomes in 29 studies. Electronic prescribing strategies reduced medication errors [RR 0.24 (95% CI 0.13, 0.46), I298%, n=11] and dosing error [RR 0.17 (95% CI 0.08, 0.38), I296%, n=9]. There was a significant effect of electronic prescribing strategies on adverse drug events (ADEs) [RR 0.52 (95% CI 0.40, 0.68), I20%, n=2] and preventable ADEs [RR 0.55 (95% CI 0.30, 1.01), I278%, n=3], but not on hypoglycemic events [RR 1.03 (95% CI 0.62-1.70), I228%, n=7], length of stay [MD -0.18 (95% -1.42, 1.05) I94%, n=7], or mortality [RR 0.97 (95% CI 0.79, 1.19), I274%, n=9].

Limitations: The quality of evidence was low, with high heterogeneity.

Conclusion: Electronic prescribing strategies decreased medication errors and adverse drug events, and had no significant effect on other patient outcomes.

 


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