Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis

Nadia Roumeliotis; Jonathan Sniderman; Thomasin Adams-Webber; Newton Addo; Vijay Anand; Paula Rochon; Anna Taddio; Christopher Parshuram

doi:10.1007/s11606-019-05236-8

Effect of Electronic Prescribing Strategies on Medication Error and Harm in Hospital: a Systematic Review and Meta-analysis

J Gen Intern Med. 2019 Oct;34(10):2210-2223. doi: 10.1007/s11606-019-05236-8. Epub 2019 Aug 8.

Authors

Nadia Roumeliotis^{1

2}, Jonathan Sniderman³, Thomasin Adams-Webber⁴, Newton Addo⁵, Vijay Anand⁶, Paula Rochon⁷, Anna Taddio⁸, Christopher Parshuram^{3

8}

Affiliations

¹ Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. nadia.roumeliotis@gmail.com.
² Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, Canada. nadia.roumeliotis@gmail.com.
³ Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
⁴ Library & Archives Services, The Hospital for Sick Children, Toronto, ON, Canada.
⁵ Division of Clinical Pharmacology, Department of Medicine, UCSF, San Francisco, CA, USA.
⁶ Department of Pediatrics, Stollery Children's Hospital, Edmonton, AB, Canada.
⁷ Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada.
⁸ Child Health Evaluative Sciences, and Center for Safety Research, SickKids Research Institute, Toronto, ON, Canada.

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), I² 98%, n = 11) and dosing errors (RR 0.17 (95% CI 0.08, 0.38), I² 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), I² 0%, n = 2), but not on preventable ADEs (RR 0.55 (95% CI 0.30, 1.01), I² 78%, n = 3), hypoglycemia (RR 1.03 (95% CI 0.62-1.70), I² 28%, n = 7), length of stay (MD - 0.18 (95% - 1.42, 1.05), I² 94%, n = 7), or mortality (RR 0.97 (95% CI 0.79, 1.19), I² 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.

Keywords: CDSS; CPOE; electronic prescribing; medication error; preventable adverse drug events.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Decision Support Systems, Clinical
Drug-Related Side Effects and Adverse Reactions / prevention & control*
Electronic Prescribing*
Humans
Medication Errors / prevention & control*
Medication Errors / statistics & numerical data
Outcome Assessment, Health Care
Randomized Controlled Trials as Topic