Objectives. To assess the evidence on the effects of computerized clinical decision support systems (CDSSs) on the prevention of medication errors and adverse drug events, related implementation outcomes such as rates of medication alert overrides, and unintended consequences of use. We also summarized the literature around the effective implementation of a CDSS.
Methods. We followed the rapid review processes of the Agency for Healthcare Research and Quality Evidence-based Practice Center Program. We queried PubMed and the Cochrane Library to locate relevant systematic reviews and primary studies published from 2015 to April 2023, supplemented by a targeted review of the grey literature. We narratively synthesized the evidence and assessed the overall strength of evidence for the outcomes of interest. The protocol for the review has been registered in PROSPERO (CRD42023449710).
Findings. Our search yielded 1,335 unique abstracts, of which 33 articles met the target criteria and were included in the review (27 systematic reviews, one overview of reviews, and five primary studies). Twenty reviews (out of 22) reporting on effectiveness were rated “good” or “fair” quality. One primary study included in the narrative synthesis was rated as having a “low” risk of bias. The evidence covered the effects of CDSSs across various healthcare settings and specialties. The type of decision support provided by the CDSSs and outcomes were heterogeneous between studies. Overall, computerized provider order entry with medication-related CDSSs were associated with reduced medication errors (moderate strength of evidence) and prevention of adverse drug events (low strength of evidence). Improved or targeted medication-related CDSSs were associated with reductions of medication errors and adverse drug events (moderate strength of evidence). However, alert override rates were high and varied between studies, and the appropriateness of the overrides was largely influenced by the type of alert. Other unintended consequences included CDSS-related errors, overdependence on alerts, alert fatigue, inappropriate alert overrides, and provider burnout. An additional 48 articles focused on barriers and facilitators of CDSS implementation.
Conclusions. Overall, CDSSs reduce medication errors and adverse drug events, with moderate- and low-certainty evidence, respectively. However, there were several unintended consequences of CDSS implementation and use. The evidence of benefits and harms was generally reported in different studies with varying contexts, making the net benefit difficult to estimate. Future research should focus on measuring these outcomes and unintended consequences in the same study to generate evidence on both the benefits and harms associated with using a CDSS in the same context.
Syrowatka A, Motala A, Lawson E, Shekelle PG. Making Healthcare Safer IV: Computerized Clinical Decision Support To Prevent Medication Errors and Adverse Drug Events. Rapid Review. (Prepared by the Southern California Evidence-Based Practice Center under Contract No. 75Q80120D00003). AHRQ Publication No. 24-EHC019-6. Rockville, MD: Agency for Healthcare Research and Quality. February 2024. https://doi.org/10.23970/AHRQEPC_MHS4MEDERROR. Posted final reports are located on the Effective Health Care Program search page.
