Background and Importance Prescribing is a specific high-risk task within the paediatric medication-use process, which is why defenses are needed to prevent or stop errors. Such system-centric barriers include electronic health record (EHR) systems with computerised physician order entry (CPOE). Clinical decision support (CDS) tools can be integrated into the CPOE systems to assist safe prescribing.
Aim and Objectives The objective of this systematic review was to examine the effects of CPOE systems with CDS functions on preventing wrong dose errors in paediatric medication orders.
Material and Methods This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and Synthesis Without Meta-analysis (SWiM) items. The study protocol was registered in PROSPERO. The literature search was conducted in MEDLINE Ovid, Scopus, Web of Science and EMB Reviews in January 2022. Study selection and data extraction were carried out by two independent reviewers. After this, the quality of evidence of the included studies were assessed. Finally, vote counting method was used to evaluate the effectiveness of CPOE-CDS systems to reduce wrong dose errors.
Results A total of 18 studies published in 2007–2021 met the inclusion criteria. The most common CDS tools appearing in the studies were dose range check (n=14/18), dose calculator (n=8/18) and dosing frequency check (n=8/18). In nine studies, a specific alert function was added to the CDS tool, whereas alerts were recorded in 15 studies. A statistically significant reduction in wrong dose errors was found in eight studies. None of the studies reposted an overall increase of wrong dose errors.
Conclusion and Relevance CPOE-CDS systems have a great potential to promote paediatric medication safety. System customisation for paediatric populations, implementing CDS alerts, and the use of dose range check seem to be most useful interventions to reduce wrong dose errors. However, CPOE-CDS systems cannot prevent all wrong dose errors as human errors continue to occur. Implementation of new technology can also pose new medication safety risks, such as alert fatigue. Therefore, further studies and systematic development activities are needed to optimise the safe use of CPOE-CDS systems in paediatric care settings.
Conflict of Interest No conflict of interest
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