The effect of electronic prescribing on medication errors and adverse drug events: a systematic review

Abstract

The objective of this systematic review is to analyse the relative risk reduction on medication error and adverse drug events (ADE) by computerized physician order entry systems (CPOE). We included controlled field studies and pretest-posttest studies, evaluating all types of CPOE systems, drugs and clinical settings. We present the results in evidence tables, calculate the risk ratio with 95% confidence interval and perform subgroup analyses for categorical factors, such as the level of care, patient group, type of drug, type of system, functionality of the system, comparison group type, study design, and the method for detecting errors. Of the 25 studies that analysed the effects on the medication error rate, 23 showed a significant relative risk reduction of 13% to 99%. Six of the nine studies that analysed the effects on potential ADEs showed a significant relative risk reduction of 35% to 98%. Four of the seven studies that analysed the effect on ADEs showed a significant relative risk reduction of 30% to 84%. Reporting quality and study quality was often insufficient to exclude major sources of bias. Studies on home-grown systems, studies comparing electronic prescribing to handwriting prescribing, and studies using manual chart review to detect errors seem to show a higher relative risk reduction than other studies. Concluding, it seems that electronic prescribing can reduce the risk for medication errors and ADE. However, studies differ substantially in their setting, design, quality, and results. To further improve the evidence-base of health informatics, more randomized controlled trials (RCTs) are needed, especially to cover a wider range of clinical and geographic settings. In addition, reporting quality of health informatics evaluation studies has to be substantially improved.

Figure 2

Risk ratios of 25 studies analyzing the effect of electronic prescribing on medication errors.

Figure 3

Risk ratios of nine studies analyzing the effect of electronic prescribing on potential ADEs.

Figure 4

Risk ratios of seven studies analyzing the effect of electronic prescribing on ADEs. Shulman was excluded, because there was no event in either the intervention group or the comparision group.

Figure 5

Sub-group analysis of the effect of home-grown versus commercial systems on the relative risk reduction of medication errors (n=25).

Figure 6

Sub-group analysis of the type of comparison group on the relative risk reduction of medication errors (n=25).

Figure 7

Sub-group analysis of the effect of the level of functionality on the relative risk reduction of medication errors (n=25).