Running head: LITERATURE REVIEW
Literature Review: The Use of Clinical Systems to Improve Outcomes and Efficiencies
Charlene Ricketts
July 19, 2019
NURS 6051
Walden University
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LITERATURE REVIEW
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The Use of Clinical Systems to Improve Outcomes and Efficiencies
Safety of patients is an integral part of health care and Alotaibi and Federico (2017)
defined patient safety as the prevention, inhibition, and improvement of hostile impacts or
injuries caused by the health care actions. Singh and Sittig (2016), defined Healthcare
information technology (HIT) as the application of information processing include software
as well as computer hardware, which handle storing, accessing, sharing, and utilizing health
care knowledge, information, and data for communication and decision making. Healthcare
information technology comprises different technologies ranging from simple electronic
charting to advanced decision support system integrated with medical technology (Alotaibi &
Federico, 2017). Health information technology offers a number of possibilities to enhance
and transform health care by minimizing human errors, improving patient outcomes,
supporting care coordination, improve efficiencies of healthcare practices, and keeping a
track of evidence (Singh & Sittig, 2016). This assignment includes a review of literature on
the use of computerized physician order entry (CPOE) to improve medication errors.
Literature Review
APA Citation
Choi, I., Lee, S. M., Flynn, L., Kim, C. M., Lee, S., Kim, N. K., & Suh, D. C. (2016).
Incidence and treatment costs attributable to medication errors in hospitalized
patients. Research in Social and Administrative Pharmacy, 12(3), 428-437.
doi:10.1016/j.sapharm.2015.08.006
Summary
The study by Choi, et al. (2016) compared two hospitals where one hospital make use
of a computerized physician order entry (CPOE) system. The use of CPOE allowed for
double checking of all the medication orders. The study identified that the use of CPOE
accounted for a 30 – 80 percent reduction in medication errors. Choi, et al. (2016) identified
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that health care setting without CPOE program experienced a slightly higher rate of
medication errors, which was possibly associated with issues in communication.
Computerized physician order entry can decrease the possibility of medication errors by
offering convenient accessibility to medicine data, eradicate confusion that mainly occurs
because of the handwriting, considerably minimize transcription errors, and assist with the
detecting the errors through automated checks and timely reminders for high-risk medicines
and drug interactions (Frisse, et al., 2016). Choi, et al. (2016) identified that medication errors
are a leading cause of increasing financial burden on health care setting because of wastage
and inefficiency along with claims in case of patient harms resulting in financial losses as
well as the adverse impact on reputation. This justifies investing time and resources for the
implementation of CPOE to reduce medication errors and mitigate associated risks (Choi, et
al., 2016).
APA Citation
Sethuraman, U., Kannikeswaran, N., Murray, K. P., Zidan, M. A., & Chamberlain, J. M.
(2015). Prescription errors before and after introduction of electronic medication alert
system in a pediatric emergency department. Academic Emergency Medicine, 22(6),
714-719. doi:10.1111/acem.12678
Summary
The study by Sethuraman, et al. (2015) identified the frequency of medication errors
in pediatric emergency departments (PEDs) and aimed to identify the impact of introducing
CPOE with electronic medication alert system (EMAS) by comparing the rates of medication
errors before and after their implementation. The study compared a sample of outpatient
medication prescriptions for a duration of 5 months each prior to and after the
implementation of CPOE with EMAS. Sethuraman, et al. (2015) identified that there has
been a considerable reduction in medication errors from 10.4 to 7.3 per 100 prescriptions
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whereas drug dosage errors reduced from 8 to 5.4 per 100. The study by Sethuraman, et al.
(2015) identified a higher false positive rate for alerts and suggested further refinements for
this clinical system to address the concern of higher rate of false-positive alerts. Prgomet, et
al. (2016), identified that integrating CPOE with clinical decision support system (CDSS) can
significantly reduce medication errors as compared to a slight reduction in medication errors
by implementing CPOE as a standalone solution.
APA Citation
Prgomet, M., Li, L., Niazkhani, Z., Georgiou, A., & Westbrook, J. I. (2016). Impact of
commercial computerized provider order entry (CPOE) and clinical decision support
systems (CDSSs) on medication errors, length of stay, and mortality in intensive care
units: a systematic review and meta-analysis. Journal of the American Medical
Informatics Association, 24(2), 413-422. doi:10.1093/jamia/ocw145
Summary
Prgomet, et al. (2016) performed a systematic review and meta-analysis of the effect
of CPOE and CDSS on three outcomes in intensive care units (ICU). The three outcome of
interest in the meta-analysis include medication errors, length of stay (LOS) and mortality
rates. The study by Prgomet, et al. (2016) identified that shifting from paper-based
prescriptions to CPOE particularly in ICUs accounted for an 85 percent reduction in
medication errors. Prgomet, et al. (2016) identified the need for evaluating the effect of viable
CPOE systems on medication errors and patient outcomes among the population at higher
risk of medication errors and adverse outcomes such as ICU patients because of the gap in the
literature to further guide the big investments in implementing CPOE. The study identified
that the rate of medication errors in different studies also varied significantly possibly
because of the varied definitions of which action is considered as a medication error.
Prgomet, et al. (2016) also identified an important requirement to comprehend the type of
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medication errors occurring after the implementation of CPOE and ways to integrate
advanced level CDSS in order to ensure the capability of healthcare to offer even more
effective and safer patient care.
APA Citation
Moghaddasi, H., Sajadi, S., & Amanzadeh, M. (2016). The effect of a well-designed
computerized physician order entry on medication error reduction. Journal of Health
Management and Informatics, 3(4), 127-131. Retrieved from
http://jhmi.sums.ac.ir/index.php/JHMI/article/view/273
Summary
The study by Moghaddasi, et al. (2016) examined the impact of efficiently designed
CPOE to reduce medication errors eventually resulting in a reduction in adverse drug events
(ADEs). Paper-based prescriptions generally tend to have a number of medication errors and
eventually increases the risk of adverse drug events, which is a potential threat to the safety
of patients (Ewig, et al., 2017). Computerized physician order entry has been identified as an
appropriate alternative to paper-based prescriptions and can substantially minimize the risk of
medication errors (Dalton, et al., 2018). Moghaddasi, et al. (2016) performed a review of the
literature and reviewed studies related to the implementation of CPOE and its effects on
medication errors. The study identified that CPOE is capable of substantially reducing the
rate of critical medication errors and related ADEs; however, an inappropriate design of
CPOE program can have a negative impact on the safety of patients. Moghaddasi, et al.
(2016) identified that substituting outdated paper-based prescriptions with a well-designed
CPOE can play a substantial part in reducing medication errors with health care setting and
eventually promotes patient’s safety and in order to accomplish this CPOE must have an
appropriate design as per the latest healthcare requirements and standards.
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APA Citation
Patel, J., Ogletree, R., Sutterfield, A., Pace, J. C., & Lahr, L. (2016). Optimized computerized
order entry can reduce errors in electronic prescriptions and associated pharmacy calls
to clarify (CTC). Applied Clinical Informatics, 7(02), 587-595. doi:10.4338/ACI2015-10-RA-0140
Summary
Patel, et al. (2016) performed a study to evaluate whether optimization of CPOE is
capable of minimizing errors in e-prescriptions and reducing the frequent need of
pharmacists’ interventions specifically the requirement for call to clarify (CTC) specific
details of prescriptions. The study also conducted a secondary analysis of cost assumptions to
postulate the variance in cost prior to and after optimization changes. The study identified a
decrease in medication error from 20 percent to 13 percent after optimization changes and
estimated cost savings of $76 per 100 prescriptions. The study by Patel, et al. (2016)
eventually concluded that implementation of optimization changes to CPOE can reduce
medication error and need for CTC and eventually results in cost saving.
Summary
All five peer-reviewed articles selected to assess the use of computerized physician
order entry (CPOE) to improve medication errors indicated that the use of CPOE has been
effective in reducing medication errors. The studies also identified that incorporating CPOE
with CDSS or EMAS can further improve the effectiveness of CPOE is mitigating the risk of
medication error and relevant negative effects such as patient harm, ADE, and increased
health care cost.
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References
Alotaibi, Y. K., & Federico, F. (2017). The impact of health information technology on
patient safety. Saudi Medical Journal, 38(12), 1173. doi:10.15537/smj.2017.12.20631
Choi, I., Lee, S. M., Flynn, L., Kim, C. M., Lee, S., Kim, N. K., & Suh, D. C. (2016).
Incidence and treatment costs attributable to medication errors in hospitalized
patients. Research in Social and Administrative Pharmacy, 12(3), 428-437.
doi:10.1016/j.sapharm.2015.08.006
Dalton, K., O’Brien, G., O’Mahony, D., & Byrne, S. (2018). Computerised interventions
designed to reduce potentially inappropriate prescribing in hospitalised older adults: A
systematic review and meta-analysis. Age and Ageing, 47(5), 670-678.
doi:10.1093/ageing/afy086
Ewig, C. L., Cheung, H. M., Kam, K. H., Wong, H. L., & Knoderer, C. A. (2017).
Occurrence of potential adverse drug events from prescribing errors in a pediatric
intensive and high dependency unit in Hong Kong: An observational study. Pediatric
Drugs, 19(4), 347-355. Retrieved from
https://link.springer.com/article/10.1007/s40272-017-0222-8
Frisse, S., Röhrig, G., Franklin, J., Polidori, M. C., & Schulz, R. J. (2016). Prescription errors
in geriatric patients can be avoided by means of a computerized physician order entry
(CPOE). Zeitschrift für Gerontologie und Geriatrie, 49(3), 227-231. Retrieved from
https://link.springer.com/article/10.1007/s00391-015-0911-2
Moghaddasi, H., Sajadi, S., & Amanzadeh, M. (2016). The effect of a well-designed
computerized physician order entry on medication error reduction. Journal of Health
Management and Informatics, 3(4), 127-131. Retrieved from
http://jhmi.sums.ac.ir/index.php/JHMI/article/view/273
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Patel, J., Ogletree, R., Sutterfield, A., Pace, J. C., & Lahr, L. (2016). Optimized computerized
order entry can reduce errors in electronic prescriptions and associated pharmacy calls
to clarify (CTC). Applied Clinical Informatics, 7(02), 587-595. doi:10.4338/ACI2015-10-RA-0140
Prgomet, M., Li, L., Niazkhani, Z., Georgiou, A., & Westbrook, J. I. (2016). Impact of
commercial computerized provider order entry (CPOE) and clinical decision support
systems (CDSSs) on medication errors, length of stay, and mortality in intensive care
units: a systematic review and meta-analysis. Journal of the American Medical
Informatics Association, 24(2), 413-422. doi:10.1093/jamia/ocw145
Sethuraman, U., Kannikeswaran, N., Murray, K. P., Zidan, M. A., & Chamberlain, J. M.
(2015). Prescription errors before and after introduction of electronic medication alert
system in a pediatric emergency department. Academic Emergency Medicine, 22(6),
714-719. doi:10.1111/acem.12678
Singh, H., & Sittig, D. F. (2016). Measuring and improving patient safety through health
information technology: The Health IT Safety Framework. BMJ Qual Saf, 25(4), 226232. Retrieved from https://qualitysafety.bmj.com/content/25/4/226.short