The role of pharmacy computer systems in preventing medication errors.
OBJECTIVE
To describe the controversies and review the evidence about computer-aided prospective drug utilization review (PDUR) systems.


METHODS
MEDLINE search of the literature.


METHODS
Published studies of the effectiveness of computer-aided prescription screening.


RESULTS
One randomized, controlled trial and four nonrandomized studies constitute the evidence base. The five studies are inconclusive with respect to whether computer-aided prescription screening causes health care providers to take action, either because of a no difference finding or because there was no comparison group. In the one randomized, controlled trial, a substantial number of actions were taken by the control group whose members did not receive alerts. No study evaluated the total effect of screening by in-store and payer (online) systems. Specific research recommendations are made to increase the evidence base.


CONCLUSIONS
Limited and inconclusive evidence about whether these systems are effective and what system features are optimal may explain the wide variation among systems in terms of what problems are screened and may also explain clinicians' uncertainty about their value. A comprehensive national research agenda for reducing medical errors should include research on the effectiveness of computer-aided PDUR.
Chrischilles
Elizabeth A
EA
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City 52242, USA. e-chrischilles@uiowa.edu
Fulda
Thomas R
TR
Byrns
Patricia J
PJ
Winckler
Susan C
SC
Rupp
Michael T
MT
Chui
Michelle A
MA
D003199:Computer Systems; D017723:Drug Utilization Review; D008508:Medication Errors / Q000517:prevention & control*; D010605:Pharmacy Administration / Q000295:instrumentation*