Impact of Vendor Computerized Physician Order Entry on Patients With Renal Impairment in Community Hospitals

BACKGROUNDAdverse drug events (ADEs) are common among hospitalized patients with renal impairment. OBJECTIVETo determine whether computerized physician order entry (CPOE) systems with clinical decision support capabilities reduce the frequency of renally related ADEs in hospitals. DESIGN, SETTING, AND PATIENTSQuasi-experimental study of 1590 adult patients with renal impairment who were admitted to 5 community hospitals in Massachusetts from January 2005 to September 2010, preimplementation and postimplementation of CPOE. INTERVENTIONVarying levels of clinical decision support, ranging from basic CPOE only (sites 4 and 5), rudimentary clinical decision support (sites 1 and 2), and advanced clinical decision support (site 3). MEASUREMENTSPrimary outcome was the rate of preventable ADEs from nephrotoxic and/or renally cleared medications. Similarly, secondary outcomes were the rates of overall ADEs and potential ADEs. KEY RESULTSThere was a 45% decrease in the rate of preventable ADEs following implementation (8.0/100 vs 4.4/100 admissions; P<0.01), and the impact was related to the level of decision support. Basic CPOE was not associated with any significant benefit (4.6/100 vs 4.3/100 admissions; P=0.87). There was a nonsignificant decrease in preventable ADEs with rudimentary clinical decision support (9.1/100 vs 6.4/100 admissions; P=0.22). However, substantial reduction was seen with advanced clinical decision support (12.4/100 vs 0/100 admissions; P=0.01). Despite these benefits, a significant increase in potential ADEs was found for all systems (55.5/100 vs 136.8/100 admissions; P<0.01). CONCLUSIONVendor-developed CPOE with advanced clinical decision support can reduce the occurrence of preventable ADEs but may be associated with an increase in potential ADEs. Journal of Hospital Medicine 2013;8:545-552. (c) 2013 Society of Hospital Medicine