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Effects of CPOE-based medication ordering on outcomes: an overview of systematic reviews
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  • Published on:
    Does CPOE use result in significant decreases to patient harm? A word of caution
    • Peter J Gates, Postdoctoral Research Fellow Centre for Health Safety and Systems Research
    • Other Contributors:
      • Magdalena Z Raban, Postdoctoral Research Fellow
      • Ling Li, Associate Professor
      • Rae-Anne Hardie, Research Fellow
      • Johanna I Westbrook, Professor

    We are writing in response to Abraham et al.’s recent review of systematic reviews (SR) targeting the impact of computerised provider order entry (CPOE) on clinical and safety outcomes [1]. We commend the authors’ inclusion of medication errors and adverse drug events (ADE) among the outcomes assessed. This is particularly timely given the World Health Organisation’s 2017 announcement of the third Global Patient Safety Challenge to motivate actions to reduce medication errors causing actual patient harm by half in five years [2]. Abraham et al. concluded that, based on the evidence reported by three SR of inpatient populations, pooled studies showed significant reduction in ADEs with CPOE use, with considerable variation in the magnitude of relative risk reduction [1]. However, there are significant limitations to the studies on which this conclusion is based, and we believe a more cautious approach should be taken when assessing the current evidence.

    Firstly, as the authors acknowledged, there was variation in the definitions of ADE across the three SR and the 18 studies they included. We agree that these are significant limitations when trying to summarise the impact of CPOE on ADE. To be clear, the included studies assessed preventable ADEs (10 studies) and/or potential ADEs (15 studies), and three studies did not specify the type of ADE. An ADE can be preventable, non-preventable, or potential [3]. A preventable ADE refers to a medication error which reached the...

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    Conflict of Interest:
    None declared.