Implementation of a new health information technology for the management of cancer chemotherapies

Abstract

BackgroundCancer chemotherapy drugs are classified as high-risk molecules. Safety of the cancer chemotherapy process is often achieved with the implementation of a health information technology to each step or to the entire process. However, computerisation could lead to the emergence of new unintended medication errors. The aim of the study was to evaluate the impact of new software designed for the management of anticancer chemotherapies.MethodThe cartography of the process and the failure modes, effects and criticality analysis were performed by a multidisciplinary team. Criticality indexes were calculated considering or not the implementation of the commercial software (CytoWeb). Quality and satisfactory indicators were measured before the implementation and during the use of the software.ResultsOur results demonstrated the complexity of the cancer chemotherapy process in the hospital. Risk analysis highlighted the positive impact of CytoWeb on the process safety but pointed out some steps that were not positively influenced by the software. Although a decrease of 38.6% of error rate was observed with the electronic system, new unintended medication errors emerged. These errors were due to inadequate use of the software (encoding of the wrong drug, the wrong dose, the wrong patient parameters or lab results and lack of prescriber adherence). Our satisfaction survey showed that the hospital pharmacists and doctors were less satisfied by the software than the nurses, mostly in terms of task achievement and time saving. Survey’s results highlighted some weaknesses in the user training and in the collaboration between the medical staff.ConclusionsOur work showed the emergence of unintended medication errors linked to computerisation that were due to an inadequate use of the software. Other issues were highlighted such as the lack of collaboration between the medical staff, the lack of prescriber implication and weaknesses in the user training or in the information related to CytoWeb.

Advanced prescription of injectable anticancer drugs: Safety assessment in a European Comprehensive Cancer Centre using the risk matrix approach

“…The minimum CI was 1 (i.e., negligible criticality: acceptable risk situations as they are, corresponding to a low risk) and the maximum CI was 25 (i.e., maximum criticality: risky situations that are not acceptable as they are, requiring analysis and corrective measures to reduce the risk to at least one risk to watch). Criticality was classified as minor (1-5), medium (6)(7)(8)(9)(10)(11)(12)(13)(14)(15) or maximal (16)(17)(18)(19)(20)(21)(22)(23)(24)(25). See Table 1d in Appendix S2 (Supporting Information)…”

“…5,11,12 These electronic prescription systems, also called computerized provider order entry (CPOE), offer simplified and accelerated treatment management processes, which result in significant patient safety improvement. 13,14 However, new types of medication errors related to both failures and limitations of software have also emerged, adding to potential human and organizational errors. 2,15 The new error types can be programming errors (i.e., an error in the creation of the treatment protocol in the software), selection errors (i.e., selecting the wrong patient or the wrong protocol), software defects and errors related to the user's level of knowledge of the software.…”

Errors in prescribing injectable anticancer drugs: benefits of a pharmaceutical long-term monitoring to improve patient safety in a European comprehensive cancer centre

“…The use of computerised prescribing systems, such as Computer Provider Order Entry (CPOE), has helped to reduce errors by incorporating validated chemotherapy regimens and safety alerts. However, this has also led to new types of errors, requiring further measures 3 4. The American Society of Health-System Pharmacists (ASHP) recommends implementing checkpoints throughout the entire process, including pharmaceutical validation 5.…”

Design, implementation, and evaluation of a CPOE system in a cancer care setting: A case study on the gastric cancer patients

“…Studies show that the implementation of the CPOE system, a tool for electronic entry medications for drug ordering, especially chemotherapy agent ordering, can essentially prevent or significantly reduce the medication errors at any stage of the medication use process, especially at the prescribing phase (a 44% to 88% reduction in prescribing phase errors). [ 4 13 17 18 19 ]…”