Medication errors are common and cause substantial harm; the injuries they cause are called preventable
adverse drug events (ADEs). Studies have estimated that 2.4–3.6% of hospital admissions are caused by ADEs of which up to 69% would have been preventable. 1
The incidence rate of ADEs in hospitalized patients is thought to be between 0.7 and 6.5% of which the preventable proportion reported has ranged from 17 to 56%. 2
Since the main error in most preventable ADEs occurs at the stage of drug ordering 3
increasingly sophisticated clinical computer systems have been seen as a major opportunity to prevent inappropriate prescribing.
Clinical provider order entry (CPOE) systems are computer-assisted information systems that enable providers to write all orders, including prescribing medications. Computerized decision support systems (CDSS) are linked with CPOE to provide support for decision-making in patient care by integrating clinical and patient information. They range from simple to more complex decision support systems, 4
with all the more complex using patient-specific data and some of the most complex involving detailed clinical protocols and patient specific data. The category of decision support used and its timing within the clinical workflow are important questions to be addressed when CDSS are implemented. 5
Reminding and alerting represent an important category of providing decision support to the clinician at the point of care. In the area of prescribing, drug reminder or drug alerting systems generate information that warn healthcare staff against potential prescribing errors or support them in their prescribing decisions.
Several systematic and narrative reviews of aspects of CDSS in healthcare have shown general benefits, such as improved practitioner performance and reduced error rates. 2,6–14
A Cochrane review on computerized dosing advice even showed moderate but significant reduction in hospital stay. 15
However, none of the reviews have specifically evaluated the impact of different alerting and reminding systems in computerized medication prescribing.
Therefore, we performed a systematic review to gather evidence of the types of alerting and reminding mechanisms that are in use. Our overall objective was to evaluate the impact of these systems on clinicians' prescribing behavior. In the literature, there are no clear distinctions made between “reminders”, “alerts”, and “prompts”. These terms will therefore be used interchangeably throughout the review.