Effect of computerisation on the quality and safety of chemotherapy prescription

Abstract

Background: Chemotherapy is prescribed according to protocols of several cycles. These protocols include not only therapeutic agents but also adjuvant solvents and inherent supportive care measures. Multiple errors can occur during the prescription, the transmission of documents and the drug delivery processes, and lead to potentially serious consequences. Objective: To assess the effect of a computerised physician order entry (CPOE) system on the number of errors in prescription recorded by the centralised chemotherapy unit of a pharmacy service in a university hospital. Patients and methods: Existing chemotherapy protocols were standardised by a multidisciplinary team (composed of a doctor, a pharmacist and a nurse) and a CPOE system was developed from a File Maker Pro database. Chemotherapy protocols were progressively introduced into the CPOE system. The effect of the system on prescribing errors was measured over 15 months before and 21 months after starting computerised protocol prescription. Errors were classified as major (dosage and drug name) and minor (volume or type of infusion solution). Results: Before computerisation, 141 errors were recorded for 940 prescribed chemotherapy regimens (15%). After introduction of the CPOE system, 75 errors were recorded for 1505 prescribed chemotherapy regimens (5%). Of these errors, 69 (92%) were recorded in prescriptions that did not use a computerised protocol. A dramatic decrease in the number of errors was noticeable when 50% of the chemotherapy protocols were prescribed through the CPOE system. Conclusion: Errors in chemotherapy prescription nearly disappeared after implementation of CPOE. The safety of chemotherapy prescription was markedly improved. M edical prescription is the result of a complex cognitive process.1 As such, it must integrate several elements-namely, patient's characteristics and medical conditions, treatment goals and particulars, institutional rules and habits, and the preferences of medical and nursing staff and of the patient. Medical order sheets are an essential way of communication between doctors, nurses and pharmacists. Medication errors refer to errors in the processes of ordering, transcribing, dispensing, administering or monitoring drugs.2 They can lead to adverse drug events, some of which are preventable. Recent studies have shown that about 50% of preventable adverse drug events during treatment occur during the prescribing phase.3-5 In a study specifically on ordering of drugs, about 20% of orders were found to be poorly legible and 24% were incomplete. Chemotherapy is given according to protocols and for repeated cycles. Potent and potentially toxic drugs are used, usually given with infusion solutions. The dosage is commonly adapted to the patient's body surface area and/ or renal function. Given the complexity of existing protocols, multiple errors can occur during prescribing, transmission of documents and drug delivery, potentially leading to serious consequences. Therefore, recommendations have been published to decre...

Computerized Prescriber Order Entry in the Outpatient Oncology Setting: From Evidence to Meaningful Use

“…In total, seven unique quantitative and two unique qualitative papers met the eligibility criteria for the systematic review ( Figure 1). The research designs described in the quantitative studies included 2-arm trials [17][18][19][20] and pre-post study designs [21][22][23] . The subsection that follows describes the outcomes of the review as they relate to the original research questions.…”

“…The results of the present systematic review clearly demonstrated the paucity of oncologyspecific cpoe literature, but the studies cited here are consistent with the existing systematic reviews describing the benefits of cpoe systems 14,27 and the unanticipated outcomes 28 . The few studies included in this review demonstrate that cpoe in the oncology setting does contribute to a decline in the incidence of medication errors 17,18,[21][22][23] , as it does, in some instances, to the potential for increased errors 18,19,21,23 . The cpoe system, clinical decision supports, and associated interface elements must be carefully designed to optimize the benefits of st cpoe systems.…”

“…Voeffray et al 22 evaluated prescribing errors for 15 months before and 21 months after cpoe implementation. The error rate was 15% pre-cpoe and 5% post-cpoe, with 92% of the post-cpoe errors being found in handwritten prescriptions.…”

“…Five studies 17,18,[21][22][23] demonstrating that cpoe reduces chemotherapy medication errors in the adult outpatient setting were identified. All reported error reduction for at least some types of errors.…”

Toward Successful Migration to Computerized Physician Order Entry for Chemotherapy

“…Computerized physician order entry (cpoe) has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors [1][2][3][4][5][6][7] . Since the early 2000s, research has established a knowledge base for successful cpoe implementation and ongoing use.…”