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Computerized decision support systems: improving patient safety in nephrology

Nature Reviews Nephrology volume 7, pages 348–355 (2011)Cite this article

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Abstract

Incorrect prescription and administration of medications account for a substantial proportion of medical errors in the USA, causing adverse drug events (ADEs) that result in considerable patient morbidity and enormous costs to the health-care system. Patients with chronic kidney disease or acute kidney injury often have impaired drug clearance as well as polypharmacy, and are therefore at increased risk of experiencing ADEs. Studies have demonstrated that recognition of these conditions is not uniform among treating physicians, and prescribed drug doses are often incorrect. Early interventions that ensure appropriate drug dosing in this group of patients have shown encouraging results. Both computerized physician order entry and clinical decision support systems have been shown to reduce the rate of ADEs. Nevertheless, these systems have been implemented at surprisingly few institutions. Economic stimulus and health-care reform legislation present a rare opportunity to refine these systems and understand how they could be implemented more widely. Failure to explore this technology could mean that the opportunity to reduce the morbidity associated with ADEs is missed.

Key Points

  • Adverse drug events (ADEs) are an important cause of morbidity among patients with chronic kidney disease or acute kidney injury, with considerable financial costs to the health-care system

  • The use of information technology in the form of computerized physician order entry and clinical decision support systems has the potential to reduce incorrect drug dosing and ADEs

  • Despite the obvious benefits of computer-based strategies, both financial and cultural barriers prevent the more-widespread adaptation of these systems

  • Substantial resources that have been allocated to promote the use of information technology in medicine should be utilized to develop this technology and decide how to implement it more widely

  • Components of an ideal clinical decision support system that is tailored to maximize usage and efficiency need to be explored

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Figure 1: CPOE and CDSS integrated within the structure–process–outcome framework of the Donabedian model of patient safety.

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Authors and Affiliations

  1. Division of Nephrology, University of Virginia Health System, Box 80013, 1215 Lee Street, Charlottesville, 22908, VA, USA

    Jamison Chang & Mitchell H. Rosner

  2. Division of Nephrology, San Bortolo Hospital, Viale Rodolfi 37, 36100, Vicenza, Italy

    Claudio Ronco

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Contributions

J. Chang and M. H. Rosner researched data for the article and wrote the article. J. Chang, C. Ronco and M. H. Rosner contributed equally to discussion of content for the article and reviewing/editing of the manuscript before submission.

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Correspondence to Mitchell H. Rosner.

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Chang, J., Ronco, C. & Rosner, M. Computerized decision support systems: improving patient safety in nephrology. Nat Rev Nephrol 7, 348–355 (2011). https://doi.org/10.1038/nrneph.2011.50

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