Clinical decision support system for medication safety: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

JIA Pengli ^1,2 ,  ZHANG Mingming ¹

1. Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. School of Management, Shanxi Medical University, Taiyuan, 030001, P.R.China;

Corresponding author：

ZHANG Mingming, Email: mingming-zhang@163.com

Keywords：

Clinical decision support system; Medication error; Medication safety; Methodology quality; Overview of systematic review

DOI：

10.7507/1672-2531.201906066

Video：

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Objectives To provide an overview of whether the clinical decision support system (CDSS) was effective in reducing medication error and improving medication safety and to assess the quality of available scientific evidence.Methods PubMed, EMbase, The Cochrane Library, CBM, WanFang Data, VIP and CNKI databases were electronically searched to collect systematic reviews (SRs) on application of clinical decision support system in the medication error and safety from January, 1996 to November, 2018. Two reviewers independently screened literature, extracted data and then evaluated methodological quality of included SRs by using AMSTAR tool.g AMSTAR tool.Results A total of 20 SRs including 256 980 healthcare practitioners and 1 683 675 patients were included. Specifically, 16 studies demonstrated moderate quality and 4 demonstrated high quality. 19 SRs evaluated multiple process of care outcome: 9 were sufficient evidence, 6 were limited evidence, and 7 were insufficient evidence which proved that CDSS had a positive effect on process outcome. 13 SRs evaluated reported patient outcomes: 1 with sufficient evidence, 3 with limited evidence, and 9 without sufficient evidence.Conclusions CDSS reduces medication error by inconsistently improving process of care measures and seldom improving patient outcomes. Larger samples and longer-term studies are required to ensure a larger and more reliable evidence base on the effects of CDSS intervention on patient outcomes.

Citation： JIA Pengli, ZHANG Mingming. Clinical decision support system for medication safety: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2020, 20(3): 317-324. doi: 10.7507/1672-2531.201906066 Copy

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2.	Brennan TA, Leape L, Laird N, et al. Incidence of adverse events and negligence in hospitalized patients: Results from the Harvard Medical Practice Study I. Qual Saf Health Care, 2004, 13(2): 145-151.
3.	Lainer M, Mann E, Sönnichsen A. Information technology interventions to improve medication safety in primary care: a systematic review. Int J Qual Health Care, 2013, 25(5): 590-598.
4.	Available at: http://webmm.ahrq.gov/glossary.aspx?indexLetter.
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6.	Colombet I, Aguirre-Junco AR, Zunino S, et al. Electronic implementation of guidelines in the EsPeR system: a knowledge specification method. Int J Med Inform, 2005, 74(7-8): 597-604.
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8.	Hemens BJ, Holbrook A, Tonkin M, et al. Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review. Implement Sci, 2011, 6: 89.
9.	Seo HJ, Kim KU. Quality assessment of systematic reviews or meta-analyses of nursing interventions conducted by Korean reviewers. BMC Med Res Methodol, 2012, 12: 129.
10.	Monique WM, Marian S, Hester VE, et al. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review ? J Am Med Inform Assoc, 2011, 18(4): 327-334.
11.	Amit X, Garg MD, Neill KJ, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA, 2005, 293(3): 1223-1238.
12.	Hunt DL, Haynes RB, Hanna SE, et al. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA, 1998, 280(15): 1339-1346.
13.	Gillaizeau F. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev, 2013, (7): 1-173.
14.	Keers RN, Williams SD, Cooke J, et al. Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review. Drug Saf, 2014, 37(5): 317-332.
15.	Jia P, Zhang L, Chen J, et al. The effects of clinical decision support systems on medication safety: an overview. PLoS One, 2016, 11(12): e0167683.
16.	Sahota N, Lloyd R, Ramakrishna A, et al. Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implement Sci, 2011, 6: 91.
17.	Nieuwlaat R, Connolly SJ, Mackay JA, et al. Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review. Implement Sci, 2011, 6: 90.
18.	Bayoumi I, Al Balas M, Handler SM, et al. The effectiveness of computerized drug-lab alerts: a systematic review and meta-analysis. Int J Med Inform, 2014, 83(6): 406-415.
19.	Vervloet M, Linn AJ, van Weert JC, et al. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc, 2012, 19(5): 696-704.
20.	Shojania KG, Jennings A, Mayhew A, et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev, 2009, (3): CD001096.
21.	Bennett JW, Glasziou PP. Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials. Med J Aust, 2003, 178(5): 217-222.
22.	Walton R, Dovey S, Harvey E, et al. Computer support for determining drug dose: systematic review and meta-analysis. BMJ, 1999, 318(7189): 984-990.
23.	Tawadrous D, Shariff SZ, Haynes RB, et al. Use of clinical decision support systems for kidney-related drug prescribing: a systematic review. Am J Kidney Dis, 2011, 58(6): 903-914.
24.	Robertson J, Walkom E, Pearson SA, et al. The impact of pharmacy computerised clinical decision support on prescribing, clinical and patient outcomes: a systematic review of the literature. Int J Pharm Pract, 2010, 18(2): 69-87.
25.	Pearson SA, Moxey A, Robertson J, et al. Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007). BMC Health Serv Res, 2009, 9: 154.
26.	Johnston. Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research. Int J Pharm Pract, 1994, 18(2): 69-87.
27.	Schedlbauer A, Prasad V, Mulvaney C, et al. What evidence supports the use of computerized alerts and prompts to improve clinicians' prescribing behavior? J Am Med Inform Assoc, 2009, 16(4): 531-538.
28.	Manias E, Williams A, Liew D. Interventions to reduce medication errors in adult intensive care: a systematic review. Br J Clin Pharmacol, 2012, 74(3): 411-423.
29.	Loganathan M, Singh S, Franklin BD, et al. Interventions to optimise prescribing in care homes: systematic review. Age Ageing, 2011, 40(2): 150-162.
30.	Alldred DP, Kennedy MC, Hughes C, et al. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev, 2016, (2): CD009095.

1. Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med, 2003, 163(12): 1409-1416.
2. Brennan TA, Leape L, Laird N, et al. Incidence of adverse events and negligence in hospitalized patients: Results from the Harvard Medical Practice Study I. Qual Saf Health Care, 2004, 13(2): 145-151.
3. Lainer M, Mann E, Sönnichsen A. Information technology interventions to improve medication safety in primary care: a systematic review. Int J Qual Health Care, 2013, 25(5): 590-598.
4. Available at: http://webmm.ahrq.gov/glossary.aspx?indexLetter.
5. Clinical Decision Support Systems: An effective pathway to reduce medical errors and improve patient safety. Available at: www.intechopen.com.
6. Colombet I, Aguirre-Junco AR, Zunino S, et al. Electronic implementation of guidelines in the EsPeR system: a knowledge specification method. Int J Med Inform, 2005, 74(7-8): 597-604.
7. Higgins JPT, Green S. Cochrane handbook for systematic reviews of interventions (version 5.1.0). The Cochrane Collaboration, 2011. Available at: http://www.cochrane-handbook.org.
8. Hemens BJ, Holbrook A, Tonkin M, et al. Computerized clinical decision support systems for drug prescribing and management: a decision-maker-researcher partnership systematic review. Implement Sci, 2011, 6: 89.
9. Seo HJ, Kim KU. Quality assessment of systematic reviews or meta-analyses of nursing interventions conducted by Korean reviewers. BMC Med Res Methodol, 2012, 12: 129.
10. Monique WM, Marian S, Hester VE, et al. Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review ? J Am Med Inform Assoc, 2011, 18(4): 327-334.
11. Amit X, Garg MD, Neill KJ, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA, 2005, 293(3): 1223-1238.
12. Hunt DL, Haynes RB, Hanna SE, et al. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA, 1998, 280(15): 1339-1346.
13. Gillaizeau F. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev, 2013, (7): 1-173.
14. Keers RN, Williams SD, Cooke J, et al. Impact of interventions designed to reduce medication administration errors in hospitals: a systematic review. Drug Saf, 2014, 37(5): 317-332.
15. Jia P, Zhang L, Chen J, et al. The effects of clinical decision support systems on medication safety: an overview. PLoS One, 2016, 11(12): e0167683.
16. Sahota N, Lloyd R, Ramakrishna A, et al. Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implement Sci, 2011, 6: 91.
17. Nieuwlaat R, Connolly SJ, Mackay JA, et al. Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review. Implement Sci, 2011, 6: 90.
18. Bayoumi I, Al Balas M, Handler SM, et al. The effectiveness of computerized drug-lab alerts: a systematic review and meta-analysis. Int J Med Inform, 2014, 83(6): 406-415.
19. Vervloet M, Linn AJ, van Weert JC, et al. The effectiveness of interventions using electronic reminders to improve adherence to chronic medication: a systematic review of the literature. J Am Med Inform Assoc, 2012, 19(5): 696-704.
20. Shojania KG, Jennings A, Mayhew A, et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev, 2009, (3): CD001096.
21. Bennett JW, Glasziou PP. Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials. Med J Aust, 2003, 178(5): 217-222.
22. Walton R, Dovey S, Harvey E, et al. Computer support for determining drug dose: systematic review and meta-analysis. BMJ, 1999, 318(7189): 984-990.
23. Tawadrous D, Shariff SZ, Haynes RB, et al. Use of clinical decision support systems for kidney-related drug prescribing: a systematic review. Am J Kidney Dis, 2011, 58(6): 903-914.
24. Robertson J, Walkom E, Pearson SA, et al. The impact of pharmacy computerised clinical decision support on prescribing, clinical and patient outcomes: a systematic review of the literature. Int J Pharm Pract, 2010, 18(2): 69-87.
25. Pearson SA, Moxey A, Robertson J, et al. Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007). BMC Health Serv Res, 2009, 9: 154.
26. Johnston. Effects of computer-based clinical decision support systems on clinician performance and patient outcome: a critical appraisal of research. Int J Pharm Pract, 1994, 18(2): 69-87.
27. Schedlbauer A, Prasad V, Mulvaney C, et al. What evidence supports the use of computerized alerts and prompts to improve clinicians' prescribing behavior? J Am Med Inform Assoc, 2009, 16(4): 531-538.
28. Manias E, Williams A, Liew D. Interventions to reduce medication errors in adult intensive care: a systematic review. Br J Clin Pharmacol, 2012, 74(3): 411-423.
29. Loganathan M, Singh S, Franklin BD, et al. Interventions to optimise prescribing in care homes: systematic review. Age Ageing, 2011, 40(2): 150-162.
30. Alldred DP, Kennedy MC, Hughes C, et al. Interventions to optimise prescribing for older people in care homes. Cochrane Database Syst Rev, 2016, (2): CD009095.

Chinese Journal of Evidence-Based Medicine

Clinical decision support system for medication safety: an overview of systematic reviews

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