Computerized clinical decision support for medication prescribing and utilization in pediatrics

J Am Med Inform Assoc. Nov-Dec 2012;19(6):942-53. doi: 10.1136/amiajnl-2011-000798. Epub 2012 Jul 19.

Abstract

Background and objective: Accurate and informed prescribing is essential to ensure the safe and effective use of medications in pediatric patients. Computerized clinical decision support (CCDS) functionalities have been embedded into computerized physician order entry systems with the aim of ensuring accurate and informed medication prescribing. Owing to a lack of comprehensive analysis of the existing literature, this review was undertaken to analyze the effect of CCDS implementation on medication prescribing and use in pediatrics.

Materials and methods: A literature search was performed using keywords in PubMed to identify research studies with outcomes related to the implementation of medication-related CCDS functionalities.

Results and discussion: Various CCDS functionalities have been implemented in pediatric patients leading to different results. Medication dosing calculators have decreased calculation errors. Alert-based CCDS functionalities, such as duplicate therapy and medication allergy checking, may generate excessive alerts. Medication interaction CCDS has been minimally studied in pediatrics. Medication dosing support has decreased adverse drug events, but has also been associated with high override rates. Use of medication order sets have improved guideline adherence. Guideline-based treatment recommendations generated by CCDS functionalities have had variable influence on appropriate medication use, with few studies available demonstrating improved patient outcomes due to CCDS use.

Conclusion: Although certain medication-related CCDS functionalities have shown benefit in medication prescribing for pediatric patients, others have resulted in high override rates and inconsistent or unknown impact on patient care. Further studies analyzing the effect of individual CCDS functionalities on safe and effective prescribing and medication use are required.

Publication types

  • Review

MeSH terms

  • Decision Support Systems, Clinical*
  • Drug Dosage Calculations
  • Guideline Adherence
  • Health Plan Implementation
  • Humans
  • Medical Order Entry Systems*
  • Outcome Assessment, Health Care*
  • Pediatrics*
  • Practice Patterns, Physicians'