Effect of Computerized Provider Order Entry with Clinical Decision Support on Adverse Drug Events in the Long-Term Care Setting

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 56; no. 12; pp. 2225 - 2233
• Main Authors: Gurwitz, Jerry H., Field, Terry S., Rochon, Paula, Judge, James, Harrold, Leslie R., Bell, Chaim M., Lee, Monica, White, Kathleen, LaPrino, Jane, Erramuspe-Mainard, Janet, DeFlorio, Martin, Gavendo, Linda, Baril, Joann L., Reed, George, Bates, David W.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.12.2008; Wiley-Blackwell; Wiley Subscription Services, Inc
• Subjects: Adverse Drug Reaction Reporting Systems; Aged, 80 and over; Biological and medical sciences; clinical decision support; Clinical trials; Computerized physician order entry; computerized provider order entry; Decision Support Techniques; Drug therapy; Female; General aspects; Humans; Long term health care; Long-Term Care; Male; Medical Order Entry Systems; Medical sciences; Miscellaneous; patient safety; Preventive medicine; Public health. Hygiene; Public health. Hygiene-occupational medicine; Side effects; Human; Drug; patient safety; Iatrogenic; Support; Decision making; Information communication technology; Toxicity; computerized provider order entry; long-term care; Patient; Health service; Pharmacovigilance; Medical prescription; clinical decision support; Secondary effect; Complication; Safety; Elderly; Computer aid; Long term care; Geriatrics
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/j.1532-5415.2008.02004.x

OBJECTIVES: To evaluate the efficacy of computerized provider order entry with clinical decision support for preventing adverse drug events in long‐term care. DESIGN: Cluster‐randomized controlled trial. SETTING: Two large long‐term care facilities. PATIENTS: One thousand one hundred eighteen long‐term care residents of 29 resident care units. INTERVENTION: The 29 resident care units, each with computerized provider order entry, were randomized to having a clinical decision support system (intervention units) or not (control units). MEASUREMENTS: The number of adverse drug events, severity of events, and whether the events were preventable. RESULTS: Within intervention units, 411 adverse drug events occurred over 3,803 resident‐months of observation time; 152 (37.0%) were deemed preventable. Within control units, there were 340 adverse drug events over 3,257 resident‐months of observation time; 126 (37.1%) were characterized as preventable. There were 10.8 adverse drug events per 100 resident‐months and 4.0 preventable events per 100 resident‐months on intervention units. There were 10.4 adverse drug events per 100 resident‐months and 3.9 preventable events per 100 resident‐months on control units. Comparing intervention and control units, the adjusted rate ratios were 1.06 (95% confidence interval (CI)=0.92–1.23) for all adverse drug events and 1.02 (95% CI=0.81–1.30) for preventable adverse drug events. CONCLUSION: Computerized provider order entry with decision support did not reduce the adverse drug event rate or preventable adverse drug event rate in the long‐term care setting. Alert burden, limited scope of the alerts, and a need to more fully integrate clinical and laboratory information may have affected efficacy.