Computerized Physician Order Entry Research Articles

Understanding how physician perceptions of job demand and process benefits evolve during CPOE implementation

ABSTRACT We examine how physicians’ perceptions of two computerized provider order entry (CPOE) capabilities, standardisation of care protocols and documentation quality, are associated with their perceptions of turnaround time, medical error, and job demand at three phases of CPOE implementation: pre-go-live, initial use, and continued use. Through a longitudinal study at a large urban hospital, we find standardisation of care protocols is positively associated with turnaround time reduction in all phases but positively associated with job demand increase only in the initial use phase. Standardisation also has a positive association with medical error reduction in the initial use phase, but later this effect becomes fully mediated through turnaround time reduction in the continued use phase. Documentation quality has a positive association with medical error reduction in the initial use phase and this association strengthens in the continued use phase. Our findings provide insights to effectively manage physicians’ response to CPOE implementation.

Medicatiefouten met methotrexaat: casuïstiek en opportuniteiten door de bril van de ziekenhuisapotheker

Medication errors with methotrexate: new insights into an old drug Methotrexate (MTX) was first used in 1948 to treat childhood leukaemia. Nowadays, it is used for the treatment of inflammatory diseases, such as rheumatoid arthritis (RA), psoriasis, psoriatic arthritis and inflammatory bowel disease. MTX is a folic acid antagonist that binds dihydrofolate reductase and thereby inhibits the synthesis of deoxyribonucleic acid (DNA), ribonucleic acid (RNA) and proteins. As an incontestable cornerstone in the treatment of RA, MTX should be started as soon as RA is diagnosed. The primary goal of the treatment is rapid and effective disease control to prevent long-term damage to the joints. For the treatment of patients with RA, the usual starting dose of MTX is 7.5-10 mg per week. Based on the clinical response, the dose could be increased to reach the optimal dose. The most common adverse drug events of MTX therapy are gastro-intestinal intolerance, haematological abnormalities, alopecia, hepatotoxicity and pulmonary toxicity. Overall, MTX is well tolerated. However, fatal cases of MTX intoxication have been reported in literature, mainly due to the daily intake and thus overdose of MTX. Despite the widespread experience with MTX, medication errors still occur with a risk of potentially severe adverse drug events. Clinical pharmacy interventions aim to detect these medication errors in inpatients. Based on a case series within a hospital population, the most common medication errors with MTX are presented. Subsequently, specific interventions to optimize medication safety with MTX therapy are described. The implementation of a specific chemotherapy module in the computerized physician order entry and clinical pharmacy interventions, such as medication reconciliation, the engagement of clinical pharmacists on hospital wards as part of the interdisciplinary team and prescription validation based on clinical rules, can contribute to a safer use of MTX.

Pursuing appropriateness of laboratory tests: a 15-year experience in an academic medical institution.

Appropriateness in Laboratory Medicine has been the object of various types of interventions. From published experiences, it is now clear that to effectively manage the laboratory test demand it is recommended to activate evidence-based preventative strategies stopping inappropriate requests before they can reach the laboratory. To guarantee appropriate laboratory test utilization, healthcare institutions should implement and optimize a computerized provider order entry (CPOE), exploiting the potential of electronic requesting as "enabling factor" for reinforcing appropriateness and sustaining its effects over time. In our academic institution, over the last 15 years, our medical laboratory has enforced various interventions to improve test appropriateness, all directly or indirectly based on CPOE use. The following types of intervention were implemented: (1) applying specific recommendations supported by monitoring by CPOE as well as a continuous consultation with clinicians (tumour markers); (2) removing outdated tests and avoiding redundant duplications (cardiac markers, pancreatic enzymes); (3) order restraints to selected wards and gating policy (procalcitonin, B-type natriuretic peptide, homocysteine); (4) reflex testing (bilirubin fractions, free prostate-specific antigen, aminotransferases, magnesium in hypocalcemia); and (5) minimum retesting interval (D-Dimer, vitamin B12, C-reactive protein, γ-glutamyltranspeptidase). In this paper, we reviewed these interventions and summarized theiroutcomes primarily related to the changes in total test volumes and cost savings, without neglecting patient safety. Our experience confirmed that laboratory professionals have an irreplaceable role as "stewards" in designing, implementing, evaluating, and maintaining interventions focused to improving test appropriateness.

Creating Meaningful Alerts and Reducing Alert Fatigue: Strategies Implemented by Informatics Pharmacists to Optimize Dose Range Checking Alerts in a Multihospital Health System.

Background: Among the many clinical decision support (CDS) mechanisms available in electronic health record (EHR) systems, dose range checking (DRC) is one of the most impactful safeguard tools integrated within most computerized provider order entry (CPOE) workflows. Unfortunately, improper configurations and lack of resources to maintain and monitor CDS systems can hinder and even disrupt daily clinical operations. Objective: This article seeks to highlight the impact that informatics pharmacists can make by implementing different strategies to decrease nuisance alerts and create clinically meaningful DRC alerts that guide clinicians in their practice. Methods: Following the activation of the DRC application for 3623 medication groupers (ie, generic drugs and all their dosage form variations), informatics pharmacists implemented strategies to monitor DRC alert output and decrease the number of inappropriate alerts. Such strategies included weekly monitoring of alerts, modification of order sentences (including dose, route, and age/weight filters), update to the rule triggering the alerts, and modifications of the preference settings. Results: From July to September 2018, an average of 70 DRC tables were reviewed by informatics pharmacists, reducing the number of overridden DRC alerts to 4796 in the first week of September-a 63% decrease in a 3-month period. Conclusions: By reducing the number of DRC nuisance alerts and improving the clinical content of DRC alerts, informatics pharmacists can contribute to lowering alert fatigue and improving providers' trust in CDS alerts.

Benefit of medication reviews by renal pharmacists in the setting of a computerized physician order entry system with clinical decision support.

A 'renal pharmacist consultant service' (RPCS) reviewing patients' charts with renal impairment (RI) for drug-related problems (DRP) can foster patient safety. However, the benefit of this service in the new setting of a computerized physician order entry (CPOE)-system with a clinical decision support (CDS)-system is unknown. The aim of our study was to evaluate the general need for an RPCS on wards with a CPOE-CDS-system already in use and its effectiveness on prescription changes to ensure in-hospital patient safety. Over a period of 3 months (02-04/2021), elective orthopaedic and trauma patients with eGFRabsolute /CrCl <60 ml/min at a German University Hospital received a medication review by a renal pharmacist for all medication entered into the CPOE-system (Meona®) by the treating physicians. Written consultations explaining identified DRP and recommending interventions to solve them, for example, dose or drug adaptation, were shared with the physicians directly in the drug chart tab of Meona®. In complex cases, DRP were additionally discussed via phone. The prescription changes were evaluated retrospectively. During 53 working days, 712 (30.5%) of 2331 screened patients were included with an eGFRnon-indexed /CrCl <60 ml/min and a pharmacist-led medication review was performed for all medication presented in the CPOE-system (Meona®). In 79 of 712 (11.1%) patients, one or more DRP were detected (median 1 DRP (1-3) per patient) and written recommendations concerning 106 of 1090 (9.7%) drugs were shared via Meona®. In total, 104 DRP were identified, mostly caused by 'dosage too high' (n=55, 52.9%), 'dosage regime wrong' (n=13, 12.5%), and 'contraindication' (n=9, 8.7%). Acceptance rate of recommendations was 74.0% (n=77/104). In nine cases (8.7%), despite of specific recommendations, no adjustment of drugs was made because of lack of alternatives. In 11 (10.6%) cases, prescription remained unchanged for unknown reasons and in seven (6.7%) cases, the result was unknown due to discharge. In the setting of prescribing in a CPOE-CDS-system, that provides physicians with advice for drug or dose adaption, the pharmacist-led medication reviews still identified DRP in orthopaedic and trauma patients with RI. A RPCS forwarding recommendations to solve DRP via the electronic medical record increased appropriate prescribing by physicians and, thus, may further improve patient safety.

Time to evaluate decision support systems for antimicrobial prescribing outside the hospital

Time to evaluate decision support systems for antimicrobial prescribing outside the hospital

Development and pilot evaluation of an electronic health record usability and safety self-assessment tool

ObjectivePoor electronic health record (EHR) usability contributes to clinician burnout and poses patent safety risks. Site-specific customization and configuration of EHRs require individual EHR system usability and safety testing which is resource intensive. We developed and pilot-tested a self-administered EHR usability and safety assessment tool, focused on computerized provider order entry (CPOE), which can be used by any facility to identify specific issues. In addition, the tool provides recommendations for improvement.Materials and MethodsAn assessment tool consisting of 104 questions was developed and pilot-tested at 2 hospitals, one using a Cerner EHR and the other using Epic. Five physicians at each site participated in and completed the assessment. Participant response accuracy compared to actual EHR interactions, consistency across participants, and usability issues identified through the tool were measured at each site.ResultsAcross sites, participants answered an average of 46 questions in 23 min with 89.9% of responses either correct or partially correct. The tool identified 8 usability and safety issues at one site and 7 at the other site across medication, laboratory, and radiology CPOE functions.DiscussionThe tool shows promise as a method to rapidly evaluate EHR usability and safety and provide guidance on specific areas for improvement. Important improvements to the evaluation tool were identified including the need to clarify certain questions and provide definitions for usability terminology.ConclusionA self-administered usability and safety assessment tool can serve to identify specific usability and safety issues in the EHR and provide guidance for improvements.

Enter and Discuss Orders and Prescriptions (EPA 4): A Curriculum for Fourth-Year Medical Students.

Order entry, entrustable professional activity (EPA) 4, is one of several EPAs that residency program directors identify as a weakness for PGY 1 residents. A multispecialty survey of program directors indicated that only 69% of interns could be trusted to enter and discuss orders and prescriptions without supervision. To address this gap, we developed a formative workshop for fourth-year medical students. Prior to the start of their subinternships, 366 fourth-year medical students engaged in an order entry workshop. Students performed chart reviews on electronic standardized patients within an educational electronic health record (EHR), placed admission orders, customized order sets, responded to safety alerts, utilized decision support tools, and incorporated high-value care considerations. Students used expert-validated rubrics to assess the quality of their admission orders and participated in a facilitated group discussion on key learning points. Finally, students participated in order entry, with all orders requiring cosignature by a supervising physician, during their clinical rotations. Students reported their confidence with order entry before and after the workshop and after the clinical rotation. One hundred seventeen students completed the pre- and postworkshop surveys, and 99 went on to complete the postcourse evaluation. Students showed a statistically significant increase in their confidence level following the workshop. Order entry is a critical, complex skill that requires deliberate instruction. This curriculum, which leverages the features of an educational EHR, can facilitate instruction, practice, and confidence gains regarding order entry prior to further application of these skills in the clinical environment.

Maintaining a medical institution in a context of materiality change: Lessons from a Canadian university hospital.

This research aimed to better understand how institutions are maintained, and the role of materiality in this institutional work. More specifically, the present qualitative case study analyzed how different actors in a large academic hospital in Canada worked together (i.e. accomplished institutional work) to maintain the institution of medical record keeping as a new clinical information system (computerized physician order entry-the material entity) was enacted. The study reveals that, to maintain the institution at stake, the intertwinement of processes of creating and maintaining institutions took place. In fact, different forms of institutional work interact Results also strongly suggest that the design of computerized physician order entry and its implementation (i.e. the materiality involved in this institutional change) played an important role in the maintenance of the institution of medical record keeping: on the one hand, it was particularly present in three types of institutional work, namely enabling, policing, and deterring; on the other hand, it appeared to be an essential component of the routinization of work by allowing a better fit between the new technology and the organization of work.

The effect of Computerised Physician Order Entry on prescribing errors: An interrupted time-series study at a secondary referral hospital in Australia

BackgroundComputerised Physician Order Entry (CPOE) software is increasingly used across the world to improve medication safety. However, few high-quality studies have reviewed the impact of CPOE on prescribing errors and patient harm. ObjectiveTo investigate the effect of a hybrid CPOE-paper prescribing system on prescribing errors at a secondary hospital site. DesignAn interrupted time-series study was conducted by identifying prescribing errors via prospective medical chart review before and after the implementation of CPOE across three medical wards. ParticipantsThe medication orders of all patients admitted to the medical wards during the study period were reviewed. InterventionImplementation of a CPOE across three medical wards. MeasuresA blinded expert panel risk stratified the errors according to level of severity, preventability and potential for harm. Pearson’s chi square and segmented regressions were used to determine if there were differences in prescribing errors pre- and post-CPOE implementation. Key resultsA total of 10,535 medication orders were reviewed pre-CPOE and 13,841 medication orders reviewed post-CPOE. Analysis demonstrated that after implementation of CPOE there were reductions in the proportion of orders with one or more of any error (−30.1%, 95 %CI: −36.5%, −23.7%, p < 0.001). Reductions in the proportion of orders with one or more errors were seen across the error categories of dosing errors (-20.1%, 95 %CI: −25.1%, −15%, p < 0.001), procedural/administrative errors (-18.9%, 95 %CI: −22.8%, −15%, p < 0.001), and therapeutic errors (-2.6%, 95 %CI: −4.1%, −1%, p = 0.002). Post-CPOE there were reductions in the proportion of orders with at least one non-intercepted serious error (-12.6%, 95 %CI: −16.4%, −8.8%, p < 0.001). ConclusionThe introduction of CPOE was associated with reductions in prescribing errors. There is also evidence that this translated into a reduced risk of harm to patients post-CPOE implementation through the reduction in actual adverse drug events.

Rapid Prototyping and Implementation of Electronic Order Sets for Critically Ill Adults with COVID-19 Admitted to a Children's Hospital

Abstract Objectives An eight-bed adult coronavirus (COVID-19) critical care (CC) unit was established within our pediatric CC unit (PCCU) when SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) variants increased the CC bed demand. Our objective was to rapidly implement electronic order sets (OSs) to facilitate computerized provider order entry (CPOE) for adult patients admitted within a children's hospital. Methods OS development began from the assessment of OSs from seven adult CC units. Using a pre-existing PCCU admission template, we created two OSs: adult COVID-19 admission and ongoing care. We tested the prototypes in a multidisciplinary onsite–virtual hybrid tabletop simulation to evaluate usability within established workflows. Participants utilized role-specific profiles within the electronic health record (EHR) training environment which paralleled their computer interface, permitting charting and documentation. EHR analysts were present to gather change requests. Following implementation, we performed twice-daily huddles with end users to identify issues. Results A total of 13 multidisciplinary bedside providers participated in simulation testing of the prototypes. Two safety issues were addressed before implementation. The electronic OSs were developed, tested, and implemented within 8 days. The postimplementation huddles identified one medication addition, and no deletions were necessary. Conclusion Caring for adult COVID-19 patients within a freestanding children's hospital presents challenges and has the potential to introduce latent safety threats. Rapid development and implementation of electronic OSs within 8 days to facilitate CPOE and reduce health care provider cognitive burden relied on leveraging functionality within the EMR system, performing iterative testing with a tabletop simulation, integration into previously established workflows, and gathering post-implementation feedback for continuous improvement.

Integrated antibiotic clinical decision support system (CDSS) for appropriate choice and dosage: an analysis of retrospective data.

Decision-making for inpatient antibiotic prescribing is complex due to many considerations to be taken. So far, clinical decision support systems (CDSS) have been rarely used in antibiotic stewardship (ABS) and even less integrated in computerized physician order entry systems (CPOE). We developed a guideline-based, CPOE-integrated CDSS (ID ANTIBIOTICS) to support antibiotic selection and dosing. We compared routine antibiotic inpatient prescribing data with CDSS-generated recommendations in the initial antibiotic selection, the duration of therapies, and costs. Finally, we assessed possible benefits of the CDSS by its performance in German ABS-guideline quality indicators (ABS-QIs). The requirements of several ABS-QIs can be supported with ID ANTIBIOTICS: electronic local guidelines, electronic decision-support, renal dosage adjustments, local guideline-based initial selection (all not quantified), and therapy durations for the treatment of pneumonia (significantly) without increasing costs. Performance in ABS-QIs for extensive therapies for community-acquired pneumonia could be improved with the CDSS by 20.2% (OR 0.134; 95% CI: 0.101-0.178); for hospital-acquired pneumonia by 3.7% (OR 0.742; 95% CI: 0.629-0.877). There was no difference in median daily drug costs between real-world prescriptions and CDSS recommendations (both: € 4.78, p=0.081). In retrospective analyses, antibiotic CDSS can show possible performance in antibiotic stewardship through quality indicators (ABS-QIs). Further research and pilot testing of the software are needed to provide more insights into ABS-QI evaluation, user acceptance, and real-world effectiveness. Deep integration of antibiotic CDSS into existing medication processes without using multiple systems could contribute to the necessary acceptance of clinical practitioners.

How does a computerized physician order entry (CPOE)/clinical decision support systems (CDSS) compare with control/paper-based system to reduce medication errors?

How does a computerized physician order entry (CPOE)/clinical decision support systems (CDSS) compare with control/paper-based system to reduce medication errors?

Pediatric Dose Calculation Issues and the Need for Human Factors–Informed Preventative Technology Optimizations

Background: Dose calculation errors are one of the most common types of medication errors impacting children and they can result in significant harm. Technology-based solutions, such as computerized provider order entry, can effectively reduce dose calculation issues; however, these technologies are not always optimized, resulting in potential benefits not being fully realized. Methods: We analyzed pediatric dose-related patient safety event reports submitted to the Pennsylvania Patient Safety Reporting System using a task-analytic approach that focused on information being used in the dose calculation, calculation errors during ordering, and errors during dose preparation or administration. From these reports, we identified whether the patient was impacted by the error, the type of medication involved, and whether a technology optimization could have mitigated the issue. Results: Of the 356 reports reviewed, 326 (91.6%) met the criteria for a dose calculation issue. The 326 reports meeting criteria had the following dose calculation issue types: wrong information used in the calculation (49 of 326, 15.0%), incorrect calculation during ordering (97 of 326, 29.8%), and calculated dose was not properly used or incorrect calculation during preparation/administration (180 of 326, 55.2%). Most of these dose calculation issues impacted the patient (219 of 326, 67.2%). Analysis of these issues by patient age group and drug class also revealed interesting patterns. Technology optimizations potentially could have addressed 81.6% of the dose calculation issues identified. Conclusion: While many healthcare facilities have adopted health information technology and other devices to support the medication process, these technologies are not always optimized to address dose calculation issues. Human factors–informed recommendations, a safety checklist, and test cases for optimizing technology are provided in the context of these findings.

Successful diagnostic stewardship for Clostridioides difficile testing in pediatrics.

To reduce both inappropriate testing for and diagnosis of healthcare-onset (HO) Clostridioides difficile infections (CDIs). We performed a retrospective analysis of C. difficile testing from hospitalized children before (October 2017-October 2018) and after (November 2018-October 2020) implementing restrictive computerized provider order entry (CPOE). Study sites included hospital A (a ∼250-bed freestanding children's hospital) and hospital B (a ∼100-bed children's hospital within a larger hospital) that are part of the same multicampus institution. In October 2018, we implemented CPOE. No testing was allowed for infants aged ≤12 months, approval of the infectious disease team was required to test children aged 13-23 months, and pathology residents' approval was required to test all patients aged ≥24 months with recent laxative, stool softener, or enema use. Interrupted time series analysis and Mann-Whitney U test were used for analysis. An interrupted time series analysis revealed that from October 2017 to October 2020, the numbers of tests ordered and samples sent significantly decreased in all age groups (P < .05). The monthly median number of HO-CDI cases significantly decreased after implementation of the restrictive CPOE in children aged 13-23 months (P < .001) and all ages combined (P = .003). Restrictive CPOE for CDI in pediatrics was successfully implemented and sustained. Diagnostic stewardship for CDI is likely cost-saving and could decrease misdiagnosis, unnecessary antibiotic therapy, and overestimation of HO-CDI rates.

Comparison of Incident Investigation Outcomes and Safety Recommendations between Clinical Safety and AcciMap Experts

This paper focuses on the perception of Branford’s standardized AcciMap approach as a tool for accident analysis in healthcare. This study further builds on the previous work regarding National Health Service (NHSScotland) clinical safety practitioners’ first-time experience in applying the standardized AcciMap approach, and discusses its advantages and limitations [Ref. 1]. A series of training sessions were carried out with a clinical domain expert from the National Services Scotland (NSS) to apply the standardized AcciMap approach for health information technology (IT) analysis. The AcciMap method was used to analyze a medication error incident involving the computerized provider order entry (CPOE) system [Ref. 2] by Clinical and AcciMap experts. Outcomes and safety recommendations from both participants were then qualitatively compared and discussed to gain further insight into applying the AcciMap method.

Can CPOE Based on Electronic Order Sets Cause Unintended Consequences (Expensive and Unnecessary Tests) at the Emergency Department?

Computerized Provider Order Entry (CPOE) systems may cause unintended consequences. This study aimed to describe the on-going system for CPOE order sets, and to explore an economic evaluation at the Emergency Department. First, we developed a costs dashboard which showed us the significant and excessive use of medical tests per consultation. We identified the top 10 most widely used and most expensive tests. Additionally we noticed that the labs seemed to continually increase. Then, we found that 27% of the consultations have at least one item of laboratory practice between January and February 2020, and this represents more than 80% of the consultation costs. Health care spending has reached epic proportions globally. We think that it is time to rethink effective strategies. Maybe it is time to deactivate/remove electronic order sets (EOSs) and the functionality to develop and create their own "private" order sets, in order to eliminate waste and inefficiencies.

Reducing Pediatric Emergency Department Prescription Errors.

Prescription errors are a significant cause of iatrogenic harm in the health care system. Pediatric emergency department (ED) patients are particularly vulnerable to error. We sought to decrease prescription errors in an academic pediatric ED by 20% over a 24-month period by implementing identified national best practice guidelines. From 2017 to 2019, a multidisciplinary, fellow-driven quality improvement (QI) project was conducted using the Model for Improvement. Four key drivers were identified including simplifying the electronic order entry into prescription folders, improving knowledge of dosing by indication, increasing error feedback to prescribers, and creating awareness of common prescription pitfalls. Four interventions were subsequently implemented. Outcome measures included prescription errors per 1000 prescriptions written for all medications and top 10 error-prone antibiotics. Process measures included provider awareness and use of prescription folders; the balancing measure was provider satisfaction. Differences in outcome measures were assessed by statistical process control methodology. Process and balancing measures were analyzed using 1-way analysis of variance and χ2 testing. Before our interventions, 8.6 errors per 1000 prescriptions written were identified, with 62% of errors from the top 10 most error-prone antibiotics. After interventions, error rate per 1000 prescriptions decreased from 8.6 to 4.5 overall and from 20.1 to 8.8 for top 10 error-prone antibiotics. Provider awareness of prescription folders was significantly increased. QI efforts to implement previously defined best practices, including simplifying and standardizing computerized provider order entry (CPOE), significantly reduced prescription errors. Synergistic effect of educational and technological efforts likely contributed to the measured improvement.

Impact of computerized physician order entry system on parenteral nutrition medication errors in a teaching neonatal intensive care unit

Parenteral nutrition (PN) offers a quality therapeutic option when enteral feeding is non-tolerated or impossible. However, it can be associated with an increased risk of medical errors, especially in sensitive populations such as newborns. This study aimed at determining the impact of the implementation of a computerized physician order entry (CPOE) system on PN medication errors in the neonatology department in the largest teaching hospital in Tunisia. The frequency of medication errors in PN, in a teaching neonatal intensive care unit, was prospectively reviewed by a pharmacist between December 2018 and March 2019 in a two-phase interventional study (pre and post locally developed CPOE System implementation). Implementation of CPOE system decreased PN order errors from 379 to 147 representing a 61.1% reduction. The decreases on PN order errors per stage, i.e. prescribing and preparation, were form 207 to 22 (89.4%), and from 117 to 66 (43.6%), respectively. Mean nutrients intakes were in conformity to the recommended daily intakes during the CPOE phase of the study. CPOE is a protective tool against prescription and preparation errors. It significantly impacted all items of the ordering process. In addition to the rigorous application of the recommendations, the CPOE system allows to reduce the risk of PN medication errors. This improves the safety and quality of medicines in newborns.

Impact of Computerized Provider Order Entry on Chemotherapy Medication Errors: A Systematic Review

Context: Chemotherapy errors are considered the second most common cause of fatal medication errors (ME). Currently, computerized provider order entry (CPOE) is increasingly used to prevent or decrease ME and improve the safety of the medication process. Objectives: This study was conducted to systematically review the impacts of CPOE on the incidence of chemotherapy ME, the severity of errors, and adverse drug events (ADEs) in cancer care units. Data Sources: The literature search was conducted, using 5 databases of PubMed, EMBASE, Scopus, Web of Science, and ScienceDirect between 2000 and 2020. Search terms included keywords and MESH terms related to CPOE, ME, chemotherapy, and cancer care unit. Study Selection: Articles were included in this research if they investigated the CPOE system, reported ME, and were carried out in the oncology department. Non-English papers, duplications, review studies, and conference papers were excluded. Data Extraction: The selected papers were checked carefully and related data were extracted. All eligible articles were qualitatively evaluated with a tool provided by Downs. The extracted information included the author’s name, year of publication, study location, type of study, study objectives, and main findings. Results: A total of 829 studies were retrieved. Fourteen articles met the inclusion criteria. Ten studies (71%) reported the impact of CPOE on chemotherapy ME in comparison with the paper-based ordering method. In 4 studies (29%), researchers developed a CPOE for the oncology department, and the system was then assessed concerning user experience, safety challenges as well as the effects of CPOE on ME. Nine articles (64%) reported the impact of the CPOE system on ME only in the prescribing phase, and 5 studies (36%) examined ME in all phases of the chemotherapy process. Five studies (36%) reported the impact of the CPOE system on ADEs and the severity of errors. Conclusions: Implementing CPOE is associated with a significant reduction in ME in all phases of the chemotherapy process. However, the CPOE does not prevent all MEs and may cause new difficulties. The rigorous analysis of the chemotherapy process and considering the designing principles could help developing well-designed CPOEs and minimizing ME.