Impact of Computerized Provider Order Entry (CPOE) Systems on Patient Safety in Saudi Arabian Hospitals


Patient safety in hospitals has significantly been associated with the high rate of medical errors in hospitals. There are a number of attributions to this; longer hospital stays, significant morbidity, death and even increased costs. There is obviously greater severity in complex hospital units, for instance the Intensive Care Unit, compared to other general units (Hug et al, 2012). This increase in the prevalence of errors has been associated with a number of other factors by Moyen et al (2008); the type of medication being used by the patients, the severity of the condition being treated and the ICU environment.

The prevalence of these errors directly affecting patient safety necessitated interventions aimed at preventing them to occur. These interventions include the Clinical Decision Support Systems (CDSSs) and the Computerized Provider Order Entry (CPOE). There has been a significant reported reduction in hospital errors as to the impact of CPOE in hospitals. The Length of stay and changes in morbidity has however not been significant. The implementation of CPOE in homegrown systems is more likely, according to reviews, to display positive effects towards patient safety and care (Prgomet et al, 2017). This is because these systems are directly controlled by the institution implementing the system.


This study looks at this impact in both homegrown and commercial CPOE systems in Saudi Arabia. Although there are studies that depict the impact of these sophisticated systems, there is need to specifically highlight the need to examine and evaluate the impact of CPOE on errors and patient safety, which would guide wider and better implementation in Saudi Arabia.

Objectives of the Study

Aim of the study

From the onset, the aim of the study is to conduct a critical analysis on the impact of computerized provider order entry on patient safety in health care settings.

Specific objectives

In order to achieve the main goal of analyzing the impact of CPOE on patient safety, the study seeks to achieve the following:

1. The study seeks to conduct a systematic review on the literature that looks at the impact of commercial CPOE on errors in hospitals and the quality of health care

2. The study will analyze and systematically evaluate the evidence on the impact of implementation of CPOE in hospitals

3. The study will quantitatively look at and analyze the evidence on both the positive and negative effects of the use of CPOE in medical care settings

4. The study will also examine and assess the needs, processes and experiences associated with the implementation of CPOE systems in health care organizations in Saudi Arabia

Secondary objectives

In the course of the study, evidence on the major barriers associated with the adoption and implementation of CPOE systems will also be analyzed. Such barriers include the resistance to change and the implementation costs.

Materials and Methods

In order to assess the risks and the impacts of implementation, a survey should be conducted. The best method of assessment would involve collecting different perceptions of the process from the relevant clinical study group.

Study area/setting

The study is based on Saudi Arabia as its setting. CPOE systems play a very important role in hospitals when it comes to improvement of the quality of care and the reduction of medication errors. This is no different in Saudi Arabia; results shown would generalize the impact of CPOE systems in care settings in Saudi Arabia, particularly in Hail City.

Study subjects

The study will focus only on the population affected by the implementation of CPOE. Consequently, the study will look at the physicians, nurses and the pharmacists.

Study design

The design adopted is the case control study as the study involves people chosen with the experiences after implementation.

Sample size

The study estimates a sample population of 203 participants.

Sampling technique

The technique used to pick the population will be randomized within the study setting; focus will however be given to pharmacists, physicians and nurses.

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Data Collection methods, instruments used, measurements

The study will adopt the use of questionnaires in the conduction of its survey; See appendix 1. The quality of the research instruments used is directly indicated by its reliability and validity. The validating process is meant to largely reduce the measurement areas (Kimberlin & Winterstein, 2008). In this survey, many of the variables in outcomes and interests are abstract concepts, particularly known as theoretical constructs. The study will use questionnaires that are reliable and valid to measure the constructs.

Data Management and Analysis Plan

The study will then systematically analyze the data collected and compare it with evidence collected on the impact of the implementation of CPOE in health care settings.

Bibliographic Reference

Bonnabry, P., Despont-Gros, C., Grauser, D., Casez, P., Despond, M., Pugin, D., Rivara-Mangeat, C., Koch, M., Vial, M., Iten, A. and Lovis, C., 2008. A risk analysis method to evaluate the impact of a computerized provider order entry system on patient safety. Journal of the American Medical Informatics Association, 15(4), pp.453-460.

Hoonakker, P.L., Carayon, P. and Walker, J.M., 2010. Measurement of CPOE end-user satisfaction among ICU physicians and nurses. Applied clinical informatics, 1(03), pp.268-285.

Hoonakker, P., Cartmill, R.S., Carayon, P. and Walker, J.M., 2013. Development and psychometric qualities of the SEIPS survey to evaluate CPOE/EHR implementation in ICUs. In Healthcare Information Technology Innovation and Sustainability: Frontiers and Adoption (pp. 161-179). IGI Global.

Hug, B., Keohane, C., Seger, D. (2012) The costs of adverse drug events in community hospitals. Jt Comm J Qual Patient Saf

Kimberlin, C., Winterstein, A. (2008) Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm

Kuperman, G.J., Teich, J.M., Gandhi, T.K. and Bates, D.W., 2001. Patient safety and computerized medication ordering at Brigham and Women’s Hospital. The Joint Commission journal on quality improvement, 27(10), pp.509-521.

Moyen, E., Camire, E., Stelfox, H (2008) Clinical review: medication errors in critical care. Crit Care; 12(2):208

Prgomet, M., Li, L., Niazkhani, Z., Georgiou, A., Westbrook, J. (2017) Impact of commercial computerized provider order entry (CPOE) and clinical decision support systems (CDSSs) on medication errors, length of stay, and mortality in intensive care units: a systematic review and meta- analysis. Journal of the American Medical Informatics Association

Upperman, J.S., Staley, P., Friend, K., Neches, W., Kazimer, D., Benes, J. and Wiener, E.S., 2005. The impact of hospitalwide computerized physician order entry on medical errors in a pediatric hospital. Journal of pediatric surgery, 40(1), pp.57-59.



Reference scores for the items in POESUS in three studies (A, B and C): Means (on a scale from 1-7), stan-dard deviations (SD), sample size [N] comparisons (Comp.) and statistically significant differences (Sign.) between the three studies. (Hoonker et al., 2010)

Reference scores for the items Reference scores for the items

Note: Comp = Comparison, Sign = Significance. *, **, *** = statistically different at p 0.05, p 0.01, and p 0.001 respectively.

Items 3, 6, 10 and 12 are in reversed order meaning that a low(er) score is favorable.

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