Abstract

Background

Prescribing is a high-risk task within the pediatric medication-use process and requires defenses to prevent errors. Such system-centric defenses include electronic health record systems with computerized physician order entry (CPOE) and clinical decision support (CDS) tools that assist safe prescribing. The objective of this study was to examine the effects of CPOE systems with CDS functions in preventing dose errors in pediatric 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 (CRD42021277413). The final literature search on MEDLINE (Ovid), Scopus, Web of Science, and EMB Reviews was conducted on 10 September 2023. Only peer-reviewed studies considering both CPOE and CDS systems in pediatric inpatient or outpatient settings were included. Study selection, data extraction, and evidence quality assessment (JBI critical appraisal tool assessment and GRADE approach) were carried out by two individual reviewers. Vote counting method was used to evaluate the effects of CPOE–CDS systems on dose errors rates.

Results

A total of 17 studies published in 2007–2021 met the inclusion criteria. The most used CDS tools were dose range check (n = 14), dose calculator (n = 8), and dosing frequency check (n = 8). Alerts were recorded in 15 studies. A statistically significant reduction in dose errors was found in eight studies, whereas an increase of dose errors was not reported.

Conclusions

The CPOE–CDS systems have the potential to reduce pediatric dose errors. Most beneficial interventions seem to be system customization, implementing CDS alerts, and the use of dose range check. While human factors are still present within the medication use process, further studies and development activities are needed to optimize the usability of CPOE–CDS systems.

中文翻译：

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使用计算机化医师医嘱输入和临床决策支持来防止儿科用药医嘱中的剂量错误：系统评价

摘要

背景

处方是儿科用药过程中的一项高风险任务，需要采取防御措施来防止错误。这种以系统为中心的防御措施包括具有计算机化医嘱输入（CPOE）的电子健康记录系统和协助安全处方的临床决策支持（CDS）工具。本研究的目的是检查具有 CDS 功能的 CPOE 系统在预防儿科用药医嘱剂量错误方面的效果。

材料与方法

本研究遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 2020 标准和无荟萃分析的综合 (SWiM) 项目。该研究方案已在 PROSPERO 中注册（CRD42021277413）。MEDLINE (Ovid)、Scopus、Web of Science 和 EMB Reviews 的最终文献检索于 2023 年 9 月 10 日进行。仅纳入考虑儿科住院或门诊环境中 CPOE 和 CDS 系统的同行评审研究。研究选择、数据提取和证据质量评估（JBI 关键评估工具评估和 GRADE 方法）由两名独立评审员进行。采用计票方法评估CPOE-CDS系统对剂量错误率的影响。

结果

2007-2021 年发表的总共 17 项研究符合纳入标准。最常用的 CDS 工具是剂量范围检查 ( n = 14)、剂量计算器 ( n = 8) 和给药频率检查 ( n = 8)。15 项研究记录了警报。八项研究发现剂量误差在统计上显着减少，但没有报告剂量误差增加。

结论

CPOE-CDS 系统有可能减少儿科剂量错误。最有益的干预措施似乎是系统定制、实施 CDS 警报以及使用剂量范围检查。虽然药物使用过程中仍然存在人为因素，但需要进一步的研究和开发活动来优化 CPOE-CDS 系统的可用性。