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

Abstract

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.