Effect of Computerisation on the Quality and Safety of Chemotherapy Prescription

Overview

Journal Qual Saf Health Care

Specialty Health Services

Date 2006 Dec 5

PMID 17142590

Citations 33

Authors

Marc Voeffray

Andre Pannatier

Roger Stupp

Nadia Fucina

Serge Leyvraz

Jean-Blaise Wasserfallen

Affiliations

Soon will be listed here.

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.

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References

Teich J, Merchia P, Schmiz J, Kuperman G, Spurr C, Bates D . Effects of computerized physician order entry on prescribing practices. Arch Intern Med. 2000; 160(18):2741-7. DOI: 10.1001/archinte.160.18.2741. View

Kim G, Chen A, Arceci R, Mitchell S, Kokoszka K, Daniel D . Error reduction in pediatric chemotherapy: computerized order entry and failure modes and effects analysis. Arch Pediatr Adolesc Med. 2006; 160(5):495-8. DOI: 10.1001/archpedi.160.5.495. View

Kaushal R, Shojania K, Bates D . Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med. 2003; 163(12):1409-16. DOI: 10.1001/archinte.163.12.1409. View

Kuperman G, Gibson R . Computer physician order entry: benefits, costs, and issues. Ann Intern Med. 2003; 139(1):31-9. DOI: 10.7326/0003-4819-139-1-200307010-00010. View

Weingart S, Toth M, Sands D, Aronson M, Davis R, Phillips R . Physicians' decisions to override computerized drug alerts in primary care. Arch Intern Med. 2003; 163(21):2625-31. DOI: 10.1001/archinte.163.21.2625. View

Potts A, Barr F, Gregory D, Wright L, Patel N . Computerized physician order entry and medication errors in a pediatric critical care unit. Pediatrics. 2004; 113(1 Pt 1):59-63. DOI: 10.1542/peds.113.1.59. View

Graber M . The safety of computer-based medication systems. Arch Intern Med. 2004; 164(3):339-40. DOI: 10.1001/archinte.164.3.339-b. View

Berger R, Kichak J . Computerized physician order entry: helpful or harmful?. J Am Med Inform Assoc. 2003; 11(2):100-3. PMC: 353014. DOI: 10.1197/jamia.M1411. View

Lesar T, Briceland L, Delcoure K, Parmalee J, Pohl H . Medication prescribing errors in a teaching hospital. JAMA. 1990; 263(17):2329-34. View

10.

Raisch D . A model of methods for influencing prescribing: Part II. A review of educational methods, theories of human inference, and delineation of the model. DICP. 1990; 24(5):537-42. DOI: 10.1177/106002809002400514. View

11.

. ASHP guidelines on preventing medication errors in hospitals. Am J Hosp Pharm. 1993; 50(2):305-14. View

12.

Bates D, Cullen D, Laird N, Petersen L, Small S, Servi D . Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA. 1995; 274(1):29-34. View

13.

Pestotnik S, Classen D, Evans R, Burke J . Implementing antibiotic practice guidelines through computer-assisted decision support: clinical and financial outcomes. Ann Intern Med. 1996; 124(10):884-90. DOI: 10.7326/0003-4819-124-10-199605150-00004. View

14.

Fischer D, Alfano S, Knobf M, Donovan C, Beaulieu N . Improving the cancer chemotherapy use process. J Clin Oncol. 1996; 14(12):3148-55. DOI: 10.1200/JCO.1996.14.12.3148. View

15.

Lesar T, Briceland L, Stein D . Factors related to errors in medication prescribing. JAMA. 1997; 277(4):312-7. View

16.

Winslow E, Nestor V, Davidoff S, Thompson P, Borum J . Legibility and completeness of physicians' handwritten medication orders. Heart Lung. 1997; 26(2):158-64. DOI: 10.1016/s0147-9563(97)90076-5. View

17.

Bates D, Leape L, Cullen D, Laird N, Petersen L, Teich J . Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998; 280(15):1311-6. DOI: 10.1001/jama.280.15.1311. View

18.

Cornish P, Knowles S, Marchesano R, Tam V, Shadowitz S, Juurlink D . Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005; 165(4):424-9. DOI: 10.1001/archinte.165.4.424. View

19.

Koppel R, Metlay J, Cohen A, Abaluck B, Russell Localio A, Kimmel S . Role of computerized physician order entry systems in facilitating medication errors. JAMA. 2005; 293(10):1197-203. DOI: 10.1001/jama.293.10.1197. View

20.

Nebeker J, Hoffman J, Weir C, Bennett C, Hurdle J . High rates of adverse drug events in a highly computerized hospital. Arch Intern Med. 2005; 165(10):1111-6. DOI: 10.1001/archinte.165.10.1111. View