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  • Title: Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting.
    Author: Gurwitz JH, Field TS, Rochon P, Judge J, Harrold LR, Bell CM, Lee M, White K, LaPrino J, Erramuspe-Mainard J, DeFlorio M, Gavendo L, Baril JL, Reed G, Bates DW.
    Journal: J Am Geriatr Soc; 2008 Dec; 56(12):2225-33. PubMed ID: 19093922.
    Abstract:
    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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