Impact of computerised physician order entry (CPOE) on the incidence of chemotherapy-related medication errors: a systematic review

Suresh Kumar Srinivasamurthy,Ramkumar Ashokkumar,Sunitha Kodidela,Scott C Howard,Uppugunduri Satyanarayana Chakradhara Rao,Caroline Flora Samer

doi:10.1007/s00228-021-03099-9

Abstract

PurposeComputerised prescriber (or physician) order entry (CPOE) implementation is one of the strategies to reduce medication errors. The extent to which CPOE influences the incidence of chemotherapy-related medication errors (CMEs) was not previously collated and systematically reviewed. Hence, this study was designed to collect, collate, and systematically review studies to evaluate the effect of CPOE on the incidence of CMEs.MethodsA search was performed of four databases from 1 January 1995 until 1 August 2019. English-language studies evaluating the effect of CPOE on CMEs were selected as per inclusion and exclusion criteria. The total CMEs normalised to total prescriptions pre- and post-CPOE were extracted and collated to perform a meta-analysis using the ‘meta’ package in R. The systematic review was registered with PROSPERO CRD42018104220.ResultsThe database search identified 1621 studies. After screening, 19 studies were selected for full-text review, of which 11 studies fulfilled the selection criteria. The meta-analysis of eight studies with a random effects model showed a risk ratio of 0.19 (95% confidence interval: 0.08–0.44) favouring CPOE (I2 = 99%).ConclusionThe studies have shown consistent reduction in CMEs after CPOE implementation, except one study that showed an increase in CMEs. The random effects model in the meta-analysis of eight studies showed that CPOE implementation reduced CMEs by 81%.

Highlights

Medication error (ME) is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
Two studies did not mention total number of prescriptions, and we were unable to retrieve the data by correspondence with the authors [20, 21]
Meisenberg et al described CPOE (Beacon system)–related errors, such as unintended re-escalation of doses if the wrong cycle was copied while creating additional cycles; confusion while adding or deleting drug in a regimen without changing the title; retention of supportive medications even after the deletion of chemotherapy drugs; chances of overdosing when treatment days were reduced as the data was automatically updated for future cycles; and inappropriate omission of drugs if the prescriber forgot to sign the order [32]

Summary

Introduction

Medication error (ME) is defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing, order communication, product labelling, packaging, nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use [1]. ME is the ‘inappropriate use of a drug that may or may not result in harm’, and any harm occurring as a result of a ME is termed an adverse drug event (ADE) [2]. The World Health Organization (WHO) aptly launched in 2017 the third Global Patient Safety Challenge, ‘Medication Without Harm’ to reduce avoidable medication errors in all countries by over 50% by 2022 [4].

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Conclusion