Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting.
Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine; Department of Medicine, Division of Preventive and Behavorial Medicine; Department of Medicine, Division of Rheumatology
Medical Subject Headings
Adverse Drug Reaction Reporting Systems; Aged, 80 and over; Decision Support Techniques; Female; Humans; Long-Term Care; Male; Medical Order Entry Systems
Health Services Research | Medicine and Health Sciences
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.
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Citation: J Am Geriatr Soc. 2008 Dec;56(12):2225-33.