Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Ojeleye, Oluwagbemileke; Avery, Anthony; Gupta, Vaibhav; Boyd, Matthew (2013)
Publisher: Biomed Central
Journal: BMC Medical Informatics and Decision Making
Languages: English
Types: Article
Subjects: Research Article, Pharmacy order entry system, Health Policy, Medicine supply, Pharmacy computer system, Drug alert, Safety alert, Safety feature, Electronic patient medication record system, Safety warning, Health Informatics, Decision support
Background: Electronic Patient Medication Record (ePMR) systems have important safety features embedded to alert users about potential clinical hazards and errors. To date, there is no synthesis of evidence about the effectiveness of these safety features and alerts at the point of pharmacy order entry. This review aims to systematically explore the literature and synthesise published evidence about the effectiveness of safety features and alerts in ePMR systems at the point of pharmacy order entry, in primary and secondary care.\ud Methods: We searched MEDLINE, EMBASE, Inspec, International Pharmaceutical Abstracts, PsycINFO, CINHAL (earliest entry to March 2012) and reference lists of articles. Two reviewers examined the titles and abstracts, and used a hierarchical template to identify comparative design studies evaluating the effectiveness of safety features and alerts at the point of pharmacy order entry. The two reviewers independently assessed the quality of the included studies using Cochrane Collaboration’s risk of bias tool.\ud Results: Three randomised trials and two before-after studies met our criteria. Four studies involved integrated care facilities and one was hospital-based. The studies were all from the United States (US). The five studies demonstrated statistically significant reduction in medication errors in patients with renal insufficiency, pregnant women dispensed US Food Drug and Administration (FDA) risk category D (evidence of fetal risk but therapeutic benefits can outweigh the risk) or X (evidence suggests that risk to the fetus outweighs therapeutic benefits)\ud medication, first dispensing of inappropriate medications in patients aged 65 and above, co-dispensing of interacting drugs, and adverse drug events related to hyperkalaemia.\ud Conclusions: This systematic review shows that the safety features of ePMR systems are effective in alerting users about potential clinical hazards and errors during pharmacy order entry. There are however, problems such as false alerts and inconsistencies in alert management. More studies are needed from other countries and pharmacy practice settings to assess the effectiveness of electronic safety features and alerts in preventing error and reducing harm to patients.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Health & Social Care Information Centre: Prescriptions Dispensed in the Community, Statistics for England - 2001-2011 [NS]. 2012 [http://www.hscic. gov.uk/catalogue/PUB06941]
    • 2. Reason J: Human errors: Model and management. Br Med J 2000, 320:768-770.
    • 3. Forni A, Chu HT, Fanikos J: Technology utilization to prevent medication errors. Curr Drug Saf 2010, 5(1):13-18.
    • 4. Steele AW, Eisert S, Witter J, Lyons P, Jones MA, Gabow P, Ortiz E: The effect of automated alerts on provider ordering behavior in an outpatient setting. PLoS Med 2005, 2(9):e255.
    • 5. Garg AX, Adhikari NKJ, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB: Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. J Am Med Assoc 2005, 293(10):1223-1238.
    • 6. Kushniruk AW, Bates DW, Bainbridge M, Househ MS, Borycki EM: National efforts to improve health information system safety in Canada, the United States of America and England. Int J Med Inform 2013, 82(5):e149-e160.
    • 7. Magrabi F, Aarts J, Nohr C, Baker M, Harrison S, Pelayo S, Talmon J, Sittig DF, Coiera E: A comparative review of patient safety initiatives for national health information technology. Int J Med Inform 2013, 82(5):e139-e148.
    • 8. McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O'Reilly D, Tamblyn R, Hemens BJ, Basu R, Troyan S, Roshanov PS: The effectiveness of integrated health information technologies across the phases of medication management: a systematic review of randomized controlled trials. J Am Med Inform Assoc 2012, 19(1):22-30.
    • 9. Smith S, Roberts MJ: Survey: validation of pharmacy software and automation. ASHP Annual Meeting 2001, 58(Jun):P-22R.
    • 10. Institute for Safe Medication Practices: Heed this Warning! Don't Miss Important Computer Alerts. ISMP Medication Safety Alert 2007, 12(3):1-2.
    • 11. Grimsmo A: [Electronic prescriptions--without side-effects?]. Tidsskr Nor Laegeforen 2006, 126(13):1740-1743.
    • 12. Strom BL, Schinnar R: Evaluating health information technology's clinical effects. LDI Issue Brief 2011, 16(4):1-4.
    • 13. Abarca J, Colon LR, Wang VS, Malone DC, Murphy JE, Armstrong EP: Evaluation of the performance of drug-drug interaction screening software in community and hospital pharmacies. J Manag Care Pharm 2006, 12(5):383-389.
    • 14. Mansour H, Dilkhush D, Lannigan J, Whalen KL: The impact of a computerized potassium alert on adverse drug events and pharmacists' interventions. J Pharm Technol 2010, 26(2):55-59.
    • 15. Saverno KR, Hines LE, Warholak TL, Grizzle AJ, Babits L, Clark C, Taylor AM, Malone DC: Ability of pharmacy clinical decision-support software to alert users about clinically important drug-drug interactions. J Am Med Inform Assoc 2011, 18(1):32-37.
    • 16. Mackowiak LR, Hayward SL: Issues of decision support in institutional pharmacy systems. Pharm Pract Manag Q 1998, 18(1):35-45.
    • 17. Schiff GD, Klass D, Peterson J, Shah G, Bates DW: Linking laboratory and pharmacy: Opportunities for reducing errors and improving care. Arch Intern Med 2003, 163(8):893-900.
    • 18. Hartzema AG, Winterstein AG, Johns TE, De Leon JM, Bailey W, McDonald K, Pannell R: Planning for pharmacy health information technology in critical access hospitals. Am J Health Syst Pharm 2007, 64(3):315-321.
    • 19. Lin JL, Vahabzadeh M, Mezghanni M, Na PJ, Leff M, Contoreggi C: Pharmacy informatics in controlled substances research. AMIA Annual Symposium Proceedings/AMIA Symposium 2008:1025.
    • 20. Raebel MA, Charles J, Dugan J, Carroll NM, Korner EJ, Brand DW, Magid DJ: Randomized trial to improve prescribing safety in ambulatory elderly patients. J Am Geriatr Soc 2007, 55(7):977-985.
    • 21. Humphries TL, Carroll N, Chester EA, Magid D, Rocho B: Evaluation of an electronic critical drug interaction program coupled with active pharmacist intervention. Ann Pharmacother 2007, 41(12):1979-1985.
    • 22. DeYoung JL, VanderKooi ME, Barletta JF: Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. Am J Health Syst Pharm 2009, 66(12):1110-1115.
    • 23. Poon EG, Cina JL, Churchill W, Patel N, Featherstone E, Rothschild JM, Keohane CA, Whittemore AD, Bates DW, Gandhi TK: Medication dispensing errors and potential adverse drug events before and after implementing bar code technology in the pharmacy. Ann Intern Med 2006, 145(6):426-434.
    • 24. Tamblyn R: Improving patient safety through computerized drug management: the devil is in the details. Healthc Pap 2004, 5(3):52-68. discussion 82-84.
    • 25. Hazlet TK, Lee TA, Hansten PD, Horn JR: Performance of community pharmacy drug interaction software. J Am Pharm Assoc 2001, 41(2):200-204.
    • 26. Jankel CA, Martin BC: Evaluation of six computerized drug interaction screening programs. Am J Hosp Pharm 1992, 49(6):1430-1435.
    • 27. Sweidan M, Reeve JF, Brien JA, Jayasuriya P, Martin JH, Vernon GM: Quality of drug interaction alerts in prescribing and dispensing software. Med J Aust 2009, 190(5):251-254.
    • 28. Fernando B, Savelyich BSP, Avery AJ, Sheikh A, Bainbridge M, Horsfield P, Teasdale S: Prescribing safety features of general practice computer systems: evaluation using simulated test cases. Br Med J 2004, 328 (7449):1171-1172.
    • 29. Morris CJ, Savelyich BSP, Avery AJ, Cantrill JA, Sheikh A: Patient safety features of clinical computer systems: Questionnaire survey of GP views. Qual Saf Health Care 2005, 14(3):164-168.
    • 30. Schedlbauer A, Prasad V, Mulvaney C, Phansalkar S, Stanton W, Bates DW, Avery AJ: What Evidence Supports the Use of Computerized Alerts and Prompts to Improve Clinicians' Prescribing Behavior? J Am Med Inform Assoc 2009, 16(4):531-538.
    • 31. Higgins JP, Altman DG, Sterne JA: Chapter 8: Assessing risk of bias in included studies. In Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). Edited by Higgins JP, Green S. The Cochrane Collaboration; 2011 [http://www.cochrane-handbook.org]
    • 32. Hardy RW, Nance BJ, Brown ET: 'Drug Alert': system devised to prevent drug interactions. Hosp Top 1970, 48(4):83-88.
    • 33. Bhardwaja B, Carroll NM, Raebel MA, Chester EA, Korner EJ, Rocho BE, Brand DW, Magid DJ: Improving prescribing safety in patients with renal insufficiency in the ambulatory setting: the Drug Renal Alert Pharmacy (DRAP) program. Pharmacotherapy 2011, 31(4):346-356.
    • 34. Raebel MA, Carroll NM, Kelleher JA, Chester EA, Berga S, Magid DJ: Randomized trial to improve prescribing safety during pregnancy. J Am Med Inform Assoc 2007, 14(4):440-450.
    • 35. Hatton RC, Rosenberg AF, Morris CT, McKelvey RP, Lewis JR: Evaluation of contraindicated drug-drug interaction alerts in a hospital setting. Ann Pharmacother 2011, 45(3):297-308.
    • 36. Indermitte J, Beutler M, Bruppacher R, Meier CR, Hersberger KE: Management of drug-interaction alerts in community pharmacies. J Clin Pharm Ther 2007, 32(2):133-142.
    • 37. Magnus D, Rodgers S, Avery AJ: GPs' views on computerized drug interaction alerts: questionnaire survey. J Clin Pharm Ther 2002, 27(5):377-382.
    • 38. Weingart SN, Toth M, Sands DZ, Aronson MD, Davis RB, Phillips RS: Physicians' Decisions to Override Computerized Drug Alerts in Primary Care. Arch Intern Med 2003, 163(21):2625-2631.
    • 39. Murphy JE, Forrey RA, Desiraju U: Community pharmacists' responses to drug-drug interaction alerts. Am J Health Syst Pharm 2004, 61(14):1484-1487.
    • 40. Murphy JE: Drug interaction screening - what pharmacists do. ASHP Midyear Clinical Meeting 2005, 40:PI-204.
    • 41. Murphy JE: Drug interaction screening - what pharmacists and prescribers do. ASHP Midyear Clinical Meeting 2006, 41(Dec):PI-26.
    • 42. Reichley RM, Seaton TL, Resetar E, Micek ST, Scott KL, Fraser VJ, Dunagan WC, Bailey TC: Implementing a commercial rule base as a medication order safety net. J Am Med Inform Assoc 2005, 12(4):383-389.
    • 43. Nechvatal G, Rice R: Antibiotic safety: use of automated rules to create a virtual safety net. ASHP Midyear Clinical Meeting 2004, 39(Dec):P303D.
  • Inferred research data

    The results below are discovered through our pilot algorithms. Let us know how we are doing!

    Title Trust
  • Discovered through pilot similarity algorithms. Send us your feedback.

Share - Bookmark

Cite this article