5PSQ-103 Evaluation of computerised clinical decision support to improve medication safety in kazakhstani hospitals

Background Computerised clinical decision support (CCDS) functionalities have been embedded into computerised physician order entry systems with the aim of ensuring accurate and informed medication prescribing. However, as for any medical intervention, claims that CCDSs improve care processes and patient outcomes need to be rigorously assessed. Purpose Adverse drug events (ADEs) are a major cause of morbidity in hospitalised patients. CCDSs are being widely implemented with the goal of preventing ADEs, but the effectiveness of these systems remains unclear. The aim of this study is to evaluate the effects of CCDSs on medication safety and to examine the methodological and reporting quality. Material and methods We searched the specialised database Ministry of Health Patient Safety Net to identify reviews of the effect of CCDS on ADE rates in inpatient settings. We identified trials that evaluated the effects of CCDSs on medication safety by electronically searching MEDLINE and the Cochrane Library. Outcomes were determined in advance and assessed separately for process of care and patient outcomes. Results Overall findings suggest that CCDSs improved the quality of prescribing decisions, detected ADEs, triggered warning messages and reduced injury risk. Of the studies, four demonstrated a marked decrease in the serious medication error rate, one an improvement in corollary orders, two an improvement in seven prescribing behaviours, and one an improvement in nephrotoxic drug dose and frequency. Five studies demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events and one an improvement in theophylline-associated medication errors. The remaining four studies had nonsignificant results. However, implementation of CCDSs profoundly changes staff workflow, and often leads to unintended consequences and new safety issues (such as alert fatigue) which limits the system’s safety effects. Conclusion The majority of CCDSs demonstrated improvements in the process of care. The use of CCDSs can substantially reduce medication error rates, but most studies have not been powerful enough to detect differences in adverse drug events. Research is needed to evaluate a national system, to compare the various applications, to identify key components of applications and to identify factors related to the successful implementation of these systems. No conflict of interest