Theme | No. of studies contributing evidence to theme | Informal evidence example | Correspondence between themes and study outcomes |
---|---|---|---|
1. Customisation for use with children | 14 | The risk of failing to customize existing systems to assist with prescribing for pediatric patients is likely substantial. | 2 of the 3 studies with negative findings were not customised for use with children. The evaluation in the 3rd study was not designed to test the impact of package type on prescribing. |
(Holdsworth et al. 2007, p. 1064) [32] | |||
2. Stakeholder engagement | 9 | Active involvement of our intensive care staff during the design, build, and implementation stages … are prerequisites for a successful implementation. | None of the 3 studies with findings of harm described a stakeholder engagement process. |
(Del Beccaro et al. 2006, p. 294) [30] | |||
3. Fostering familiarity | 13 | Probably the most important and fundamental activity necessary for a smooth transition to CPOE is staff CPOE training … Poor training may lead to a lack of system understanding, which can result in frustration, poor acceptance, and a lack of full utilization. | The training provided in the Han et al. study has been identified as inadequate, and no training was described in the other 2 studies with harmful outcomes. Studies measuring at multiple time points show greater benefits at later follow-up. |
(Upperman et al. 2005a, p. e639) [44] | |||
4. Adequate/appropriate infrastructure | 6 | Our finding [of an increase in mortality] may reflect a clinical applications program implementation and systems integration issue rather than a CPOE issue per se. | The Han et al. study acknowledges that the harmful outcomes observed were likely due to infrastructure problems rather than EP itself. |
(Han et al. 2005, p. 1511) [31] | |||
5. Planning and iteration | 14 | It is important for hospitals to monitor, continually modify, and improve CPOE systems on the basis of data derived from their own institution. | There was a relatively limited (3Â months) preparatory phase in the Han et al. study in comparison to other studies. |
(Walsh et al. 2008, p. e427) [46] |