Chemotherapy prescribing errors: an observational study on the role of information technology and computerized physician order entry systems

Abstract

BackgroundChemotherapy administration is a high-risk process. Aim of this study was to evaluate the frequency, type, preventability, as well as potential and actual severity of outpatient chemotherapy prescribing errors in an Oncology Department where electronic prescribing is used.MethodsUp to three electronic prescriptions per patient record were selected from the clinical records of consecutive patients who received cytotoxic chemotherapy between January 2007 and December 2008. Wrong prescriptions were classified as incomplete, incorrect or inappropriate. Error preventability was classified using a four-point scale. Severity was defined according to the Healthcare Failure Mode and Effect Analysis Severity Scale.ResultsEight hundred and thirty-five prescriptions were eligible. The overall error rate was 20%. Excluding systematic errors (i.e. errors due to an initially faulty implementation of chemotherapy protocols into computerized dictionaries) from the analysis, the error rate decreased to 8%. Incomplete prescriptions were the majority. Most errors were deemed definitely preventable. According to error presumptive potential for damage, 72% were classified as minor; only 3% had the potential to produce major or catastrophic injury. Sixty-eight percent were classified as near misses; adverse drug events had no or little effect on clinical outcome.ConclusionsChemotherapy prescribing errors may arise even using electronic prescribing. Although periodic audits may be useful to detect common errors and guide corrective actions, it is crucial to get the computerized physician order entry system and set-ups correct before implementation.

The impact of a computerized physician order entry system on medical errors with antineoplastic drugs 5 years after its implementation

“…This reduction is similar to the reductions described in other articles, even when acknowledging that direct comparisons are not completely possible or they must be made with caution because of the use of heterogeneous methodologies or the use of different antineoplastic ME classifications. International studies show a reduction in MEs from 30·6% to 7% after implementing CPOE for oncohaematological prescriptions . It has also been shown that a CPOE system reduces the risk of prescription errors by 69%, when applied to oral antineoplastic drugs .…”

“…The present study showed that in a haematology setting, there was an even higher reduction rate, which was also higher than the rate reported in similar studies . This reduction could be explained by the long period of time (5 years) since the CPOE system has been implemented; during this period, physicians have had great experience in its use and the chemotherapy schedules have been fully protocolized.…”

“…Computerized physician order entry (CPOE) systems have been shown to reduce MEs not only in our hospital but also in many other settings . The ASHP guidelines on preventing MEs with antineoplastic agents suggest that CPOE systems are superior to preprinted prescription forms because CPOE systems have additional features, such as the removal of interpretation/transcription errors, the availability of information on drug doses/schedules, the automatic calculation of medication doses, and alerts and error‐checking functions …”

Operating room to intensive care unit handoffs and the risks of patient harm

“…7–9 Over the past decade, the FMECA methodology has been increasingly used in healthcare to examine high-risk care processes such as medication administration, surgical procedures, and emergency care. 10–12 This paper reports the results of an FMECA of the systems and processes involved in the OR to ICU handoff in an attempt to further understand the criticality of specific steps of the handoff. The identification of these steps should assist in better understanding the potential relationships between the handoff process and clinical outcomes.…”

Improving Patient Safety With Error Identification in Chemotherapy Orders by Verification Nurses

“…Surprisingly little evidence is available about the extent or nature of these errors, which demonstrates how safety issues related to the administration of chemotherapy are under-researched (Kullberg, Larsen, & Sharp, 2013). Despite the lack of research, some evidence suggests that errors are related to prescribing (Aita et al, 2013; Ranchon et al, 2012). …”