Avoiding chemotherapy prescribing errors: Analysis and innovative strategies

Abstract

Background At Freiburg University Medical Center, chemotherapy prescriptions are processed via a computerized physician order entry (CPOE) tool and clinically checked by a designated chemotherapy surveillance team. Any error detected is reported instantly, corrected, and prospectively recorded. The objective of the current study was to gain insight into the causes, potential consequences, and future preventability of chemotherapy prescribing errors. Methods A detailed analysis of 18,823 consecutive antineoplastic orders placed in 2013 through 2014 was performed. In cooperation with information technology (IT) specialists, the intercepted errors were analyzed for effective future prevention using IT measures. Potential error consequences were determined by case discussions between pharmacists and physicians. Results Within 24 months, a total of 406 chemotherapy prescribing errors were intercepted that affected 375 (2%) of the total orders. Errors were classified as clinically relevant in 279 of the chemotherapy orders (1.5%). In these cases, reduced therapeutic efficacy (0.44%), the need for increased monitoring (0.48%), prolonged hospital stay (0.55%), and fatality (0.02%) were avoided as potential consequences. The most efficient conventional measures for error prevention comprised checking the order history and patient’s medical record, and a detailed knowledge of chemotherapy protocols. Of all the errors analyzed, 61% would be avoided through further software development. The improvements identified are implemented through a validated next‐generation CPOE tool. Conclusions The upgraded CPOE tool can be shared across other hospitals to raise safety standards and spread potential benefits across a wider patient population. The current analysis also highlighted that approximately 30% to 40% of errors cannot be avoided electronically. Therefore, pharmacovigilance initiatives remain indispensable.

Medication errors in a cohort of pediatric patients with acute lymphoblastic leukemia on remission induction therapy in a tertiary care hospital in Mexico

“…Preventive measures or interventions should put special emphasis on prescribing and dose calculation, especially to avoid those deviations greater than 25% that involved 26.7% of total wrong doses in this study, since systematic deviations can reduce the expected treatment efficacy or facilitate the appearance of ADEs related to excessive toxicity . Said toxicity due overdose may have contributed more to mortality in our institution (0.7 per 100 MEs) than in other hospitals with surveillance systems (0.02%) …”

“…This is the first study in a tertiary care hospital in Mexico to estimate the incidence of MEs in the pediatric oncology setting. MEs were common, but could be considerably reduced with preventive measures …”

“…This may be due to the fact that our medication process has multiple transcription stages and might be prioritizing the correct transmission of the prescribed dose rather than verifying its adequateness for the patient, thus facilitating the propagation of MEs. Other prospective studies with systematic safety and medication surveillance systems intercepted between 2% and 15.4% of prescribing errors . Therefore, it is necessary to redesign our medication system in order for it to be fail‐safe.…”

“…The establishment of general measures for safe medication, such as personnel training programs, dose calculation verification by a second person (probably a nurse), body weight updating and application of standard criteria in body surface area rounding, as well as specific measures such as assistance of a clinical pharmacist , and technological assistance systems are actions that have been shown to reduce the frequency of MEs, and have the potential to increase patient safety…”

“…An ADE was defined as any unintended harm related to the chemotherapy treatment, but preceded by overdose. Intercepted prescribing errors were analyzed by the research team in order to determine the potential effects based on the patient clinical condition and the chemotherapy toxicities described in the literature . To grade the severity of ADEs and potential ADEs, the scale created by the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) was used .…”