View source for Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review

== Background ==

[[Adverse drug event |Adverse drug events (ADEs)]] is a major cause of death among medical-error-associated deaths in both inpatient and outpatient settings.  According to IOM, there are approximately 44,000-98,000 medical errors-linked deaths in the hospitalized patients in the US each year.  [[Computerized physician order entry | computerized physician order entry (CPOE)]] combined with [[Clinical decision support systems | clinical decision support system (CDSS)]] can presumably prevent occurrences of ADEs and any related severe consequences. However, it remains elusive in practice in a real-world environment.  This review article intended to summarize published results by means of systematic and narrative reviews dating back from 2008 to 2012 <ref name=" Ranji 2014"> Ranji, S. R., Rennke, S., & Wachter, R. M. (2014). Computerised provider order entry combined with clinical decision support systems to improve medication safety: a narrative review. BMJ Quality & Safety, 23(9), 773–780. http://doi.org/10.1136/bmjqs-2013-002165.</ref>.

== Methods ==

Systematic and Narrative reviews based on the following creteria<ref name=" Ranji 2014"> </ref>: 
* The specialized database from [[Agency for Healthcare Research and Quality (AHRQ) | Agency for Healthcare Research and Quality (AHRQ) ]] Patient Safety Net. 
*Key words: [[Computerized physician order entry | computerized physician order entry (CPOE)]], [[Clinical decision support systems | clinical decision support system (CDSS)]], [[Adverse drug event |adverse drug events (ADEs)]].
*Literature: published between 2008 and 2012.


== Results ==

===Covered results===

*Five systematic reviews. 
*One narrative review.
*Two controlled trials.


===Summary===

*The majority of data is derived from in-house developed systems:
#CPOE+CDSS: reduces prescribing errors consistently in the inpatient setting. 
#CPOE+CDSS: no effects on prevention of ADEs  in either the inpatient or outpatient setting. 
#CPOE+CDSS: Profoundly changes clinician workflow and subsequently introduces unintended adverse consequences such [[alert fatigue|Alert fatigue]].

== Conclusions ==

*Unfortunately, CPOE+CDSS do not convincingly reduce or prevent ADEs, despite over a decade of widespread adoption and implementation. 
*More work needs to be done in the area in order to approach the pre-defined goal.  


== Comments ==

Although the results and conclusion do not seemly support the concept of ADE prevention by combination of CPOE and CDSS, the reasons behind these consequences may or may not really be due to the failures of CPOE+CDSS.  For example, inappropriate installation and staff training could result in the failure of implementation.  Therefore, it is still too early to draw a conclusion in terms of usefulness of CPOE with CDSS in the prevention of ADEs.  

==Related Articles==
*[[Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems]]
*[[Can Utilizing a Computerized Provider Order Entry (CPOE) System Prevent Hospital Medical Errors and Adverse Drug Events?]]
*[[Features predicting the success of computerized decision support for prescribing: a systematic review of randomized controlled trials.]]

==References==

<references/>
[[Category: Reviews]] 
[[Category: EMR]]
[[Category: CPOE]]
[[Category: CDSS]]
[[Category:HI5313-2015-FALL]]