mpact 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-analysi

To conduct a systematic review and meta-analysis of the impact of commercial computerized provider order entry (CPOE) and clinical
decision support systems (CDSSs) on medication errors, length of stay (LOS), and mortality in intensive care units (ICUs).
Methods We searched for English-language literature published between January 2000 and January 2016 using Medline, Embase, and CINAHL.
Titles and abstracts of 586 unique citations were screened. Studies were included if they: (1) reported results for an ICU population; (2) evaluated
the impact of CPOE or the addition of CDSSs to an existing CPOE system; (3) reported quantitative data on medication errors, ICU LOS, hospital
LOS, ICU mortality, and/or hospital mortality; and (4) used a randomized controlled trial or quasi-experimental study design.
Results Twenty studies met our inclusion criteria. The transition from paper-based ordering to commercial CPOE systems in ICUs was associated
with an 85% reduction in medication prescribing error rates and a 12% reduction in ICU mortality rates. Overall meta-analyses of LOS and hospital
mortality did not demonstrate a significant change.
Discussion and Conclusion Critical care settings, both adult and pediatric, involve unique complexities, making them vulnerable to medication errors and adverse patient outcomes. The currently limited evidence base requires research that has sufficient statistical power to identify the true
effect of CPOE implementation. There is also a critical need to understand the nature of errors arising post-CPOE and how the addition of CDSSs
can be used to provide greater benefit to delivering safe and effective patient care