Effect of computerized provider order entry with clinical decision support on adverse drug events in the long-term care setting.

OBJECTIVES

To evaluate the efficacy of computerized provider order entry with clinical decision support for preventing adverse drug events in long-term care.

DESIGN

Cluster-randomized controlled trial.

SETTING

Two large long-term care facilities.

PATIENTS

One thousand one hundred eighteen long-term care residents of 29 resident care units.

INTERVENTION

The 29 resident care units, each with computerized provider order entry, were randomized to having a clinical decision support system (intervention units) or not (control units).

MEASUREMENTS

The number of adverse drug events, severity of events, and whether the events were preventable.

RESULTS

Within intervention units, 411 adverse drug events occurred over 3,803 resident-months of observation time; 152 (37.0%) were deemed preventable. Within control units, there were 340 adverse drug events over 3,257 resident-months of observation time; 126 (37.1%) were characterized as preventable. There were 10.8 adverse drug events per 100 resident-months and 4.0 preventable events per 100 resident-months on intervention units. There were 10.4 adverse drug events per 100 resident-months and 3.9 preventable events per 100 resident-months on control units. Comparing intervention and control units, the adjusted rate ratios were 1.06 (95% confidence interval (CI)=0.92-1.23) for all adverse drug events and 1.02 (95% CI=0.81-1.30) for preventable adverse drug events.

CONCLUSION

Computerized provider order entry with decision support did not reduce the adverse drug event rate or preventable adverse drug event rate in the long-term care setting. Alert burden, limited scope of the alerts, and a need to more fully integrate clinical and laboratory information may have affected efficacy.