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Browsing by Subject "Sähköinen terveydenhuollon toimijan määräysjärjestelmä"

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  • Ruutiainen, Henna (2022)
    In health care, the most patient safety incidents occur from medication errors, to which pediatric patients in particular are susceptible. According to James Reason's Theory of Human Error, errors inevitably occurs in an individual's actions, causing potential harm. The prescribing phase has been identified as a specific risk point in the pediatric medication-use process, and therefore defences must be established to prevent or stop errors before they reach the patient. Such system-centric barriers are, for example, electronic health record (EHR) systems that can include computerized physician order entry (CPOE) systems where e.g., medication orders and prescriptions can be made. Knowledge-based clinical decision support (CDS) tools such as dose range check or dose calculator can be integrated into the CPOE system to assist in the prescribing process. The objective of this systematic review was examine the effects of CPOE systems with CDS functions on preventing wrong dose errors in pediatric inpatient orders and outpatient prescriptions. This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 criteria and Synthesis Without Meta-analysis (SWiM) items as an extension to PRISMA criteria. The Joanna Briggs Institute’s (JBI) recommendations from JBI Manual for Evidence Synthesis on mixed methods was used as a guide to conduct this review. Additionally, Cochrane Handbook for Systematic Reviews of Interventions was utilized to conduct the synthesis examining the wrong dose error effectiveness. The study protocol according to the prior defined eligibility criteria was registered in PROSPERO. The literature search was implemented in four databases (MEDLINE Ovid, Scopus, Web of Science and EMB Reviews), reference lists and grey literature in January 2022. Two independent reviewers conducted the study selection and data extraction of the eligible studies using a Covidence software platform. Vote counting method was used to describe and analyze the quantitative findings of the studies exploring the characteristics of CPOE-CDS systems reducing wrong dose errors and regarding their effectiveness on error prevention. JBI’s critical appraisal tools and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach were used to define the quality of the studies. A total of 18 studies met the inclusion criteria. The studies had been published in 2007–2021 and majority (13/18) considered only inpatient orders. Almost all (n=16) studies had customized or homegrown CPOE-CDS system and the most used CDS tools were dose range check (78%, 14/18), dose calculator (45%, 8/18) and dosing frequency check (45%, 8/18). When implementing new or customizing the used CPOE-CDS system usually alert functions were added (n=9) and in total alerts were present in 15 studies. Statistically significant reduction in wrong dose errors (overall, overdosing or underdosing errors) was reported in eight studies. None of the studies (n=18) found an overall increase of wrong dose errors. CPOE systems with CDS functions have a great potential to reduce wrong dose errors and promote pediatric medication safety. CPOE-CDS system customization for pediatric population, implementing CDS alerts and the use of dose range check tool seem to be most advantageous when aiming to prevent wrong dose errors. However, CPOE-CDS systems cannot prevent all wrong dose errors as human errors continue to occur and the implemented CPOE-CDS systems can pose new risks such as alert fatigue. Therefore, systematic actions are needed to optimize the safe use of CPOE-CDS systems in pediatrics. More studies are needed particularly on the effectiveness on wrong dose error prevention comparing basic and advanced CDS tools and the effects of different individual CDS functions on wrong dose errors.