Use of Computerized Physician Order Entry with Clinical Decision Support to Prevent Dose Errors in Pediatric Medication Orders: A Systematic Review.

IF 3.4 3区医学 Q1 PEDIATRICS

Pediatric Drugs Pub Date : 2024-03-01 Epub Date: 2024-01-19 DOI:10.1007/s40272-023-00614-6

Henna Ruutiainen, Anna-Riia Holmström, Eva Kunnola, Sini Kuitunen

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引用次数: 0

Abstract

Background: Prescribing is a high-risk task within the pediatric medication-use process and requires defenses to prevent errors. Such system-centric defenses include electronic health record systems with computerized physician order entry (CPOE) and clinical decision support (CDS) tools that assist safe prescribing. The objective of this study was to examine the effects of CPOE systems with CDS functions in preventing dose errors in pediatric medication orders.

Material and methods: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and Synthesis Without Meta-Analysis (SWiM) items. The study protocol was registered in PROSPERO (CRD42021277413). The final literature search on MEDLINE (Ovid), Scopus, Web of Science, and EMB Reviews was conducted on 10 September 2023. Only peer-reviewed studies considering both CPOE and CDS systems in pediatric inpatient or outpatient settings were included. Study selection, data extraction, and evidence quality assessment (JBI critical appraisal tool assessment and GRADE approach) were carried out by two individual reviewers. Vote counting method was used to evaluate the effects of CPOE-CDS systems on dose errors rates.

Results: A total of 17 studies published in 2007-2021 met the inclusion criteria. The most used CDS tools were dose range check (n = 14), dose calculator (n = 8), and dosing frequency check (n = 8). Alerts were recorded in 15 studies. A statistically significant reduction in dose errors was found in eight studies, whereas an increase of dose errors was not reported.

Conclusions: The CPOE-CDS systems have the potential to reduce pediatric dose errors. Most beneficial interventions seem to be system customization, implementing CDS alerts, and the use of dose range check. While human factors are still present within the medication use process, further studies and development activities are needed to optimize the usability of CPOE-CDS systems.

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使用计算机化医嘱输入与临床决策支持防止儿科用药医嘱中的剂量错误：系统回顾

背景：开处方是儿科用药过程中的一项高风险任务，需要采取防御措施来防止出错。这种以系统为中心的防御措施包括带有计算机化医嘱输入（CPOE）和临床决策支持（CDS）工具的电子健康记录系统，这些工具有助于安全处方。本研究的目的是探讨具有 CDS 功能的 CPOE 系统在预防儿科用药单剂量错误方面的效果：本研究遵循系统综述和元分析首选报告项目（PRISMA）2020 标准和无元分析综合（SWiM）项目。研究方案已在 PROSPERO（CRD42021277413）上注册。2023 年 9 月 10 日，在 MEDLINE (Ovid)、Scopus、Web of Science 和 EMB Reviews 上进行了最终文献检索。只纳入了在儿科住院或门诊环境中同时考虑 CPOE 和 CDS 系统的同行评审研究。研究选择、数据提取和证据质量评估（JBI 关键评估工具评估和 GRADE 方法）由两名审稿人独立完成。采用计票法评估 CPOE-CDS 系统对剂量错误率的影响：共有 17 项发表于 2007-2021 年的研究符合纳入标准。使用最多的 CDS 工具是剂量范围检查（14 项）、剂量计算器（8 项）和剂量频率检查（8 项）。有 15 项研究记录了警报。有 8 项研究发现剂量错误在统计学上明显减少，而剂量错误增加的情况则未见报道：结论：CPOE-CDS 系统有可能减少儿科剂量错误。最有益的干预措施似乎是系统定制、实施 CDS 警报和使用剂量范围检查。虽然在用药过程中仍存在人为因素，但仍需进一步开展研究和开发活动，以优化 CPOE-CDS 系统的可用性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Drugs PEDIATRICS-PHARMACOLOGY & PHARMACY

CiteScore

7.20

自引率

0.00%

发文量

审稿时长

>12 weeks

期刊介绍： Pediatric Drugs promotes the optimization and advancement of all aspects of pharmacotherapy for healthcare professionals interested in pediatric drug therapy (including vaccines). The program of review and original research articles provides healthcare decision makers with clinically applicable knowledge on issues relevant to drug therapy in all areas of neonatology and the care of children and adolescents. The Journal includes: -overviews of contentious or emerging issues. -comprehensive narrative reviews of topics relating to the effective and safe management of drug therapy through all stages of pediatric development. -practical reviews covering optimum drug management of specific clinical situations. -systematic reviews that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. -Adis Drug Reviews of the properties and place in therapy of both newer and established drugs in the pediatric population. -original research articles reporting the results of well-designed studies with a strong link to clinical practice, such as clinical pharmacodynamic and pharmacokinetic studies, clinical trials, meta-analyses, outcomes research, and pharmacoeconomic and pharmacoepidemiological studies. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Pediatric Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.